Minimally Disruptive Medicine: The Burden of Treatment vs. The Burden of Disease

Posted on | August 7, 2012 | 2 Comments

Mike Magee

At the core, the Affordable Care Act is equal parts rights and responsibilities. For the historic expansion of health services as a human right, we Americans will demand in return that citizens act responsibly. Defining individual, family, community and societal responsibility is complex. Doing so while continuing to honor the delicate patient-health professional relationship represents an even greater challenge.

For some time, social scientists have recognized that these relationships are evolving – from paternalism to partnership, from individual to teams, and from directed decisions to mutual decision making. While the direction of change is clear, the nomenclature to guide this change and basics tenets to anchor our progression have been lacking. Specifically, providers of care have been more resistant to and suspicious of new approaches then have the leading edge of the consumer health movement.

We are now beginning to see emerge on the professional side a new nomenclature which may herald a significant adjustment in health delivery marked by greater equality between the people and the people caring for the people. If you would like to witness this evolution in action, I urge you to tune in to WIHI (the free radio channel of IHI – the Institute For Healthcare Improvement) this Thursday, August 9, 2012 from 2:00 – 3:00 PM Eastern Time for a discussion of “minimally disruptive medicine’.(1)

In 2009, in the British Medical Journal, sociologist, Carl May, and Mayo Clinic professor of medicine, Victor M Montori, stated, “We need to think more about the burdens of treatment. These are different from the burdens of illness. This becomes more urgent in the light of the policy emphasis on self care and what we know about its effects. More fundamentally, thinking seriously about the burden of treatment may help us begin to think about minimally disruptive medicine—forms of effective treatment and service provision that are designed to reduce the burden of treatment on their users.”(2)

The term stuck, and according to IHI ” This provocative notion definitely got the attention of health professionals in the audience at IHI’s 13th Annual Summit on Improving Patient Care in the Office Practice and the Community (March 18-20, 2012).” What really drew everyone’s interest was how Dr. Montori and his Mayo colleague, Nilay Shah, PhD took the consumer’s side on the issue of compliance. Non-compliance or non-adherence have been used for decades to explain marginal professional performance and out-of-control costs.

But Montori says, “Think of it this way. So-called ‘non-compliance’ is actually an alarm system for a health care system that’s failing patients. The goal needs to be shifting and sharing responsibility for chronic disease with patients and families — not shifting the burden.” (3) That is to say, maybe we should examine more closely the “burden of treatment” rather than the “burden of disease”, and deal the patient and family fully in. Maybe they know more than we (health professionals) know about what approaches really work and which ones are a waste of time, money and effort.

To flesh out what they mean by the term “minimally disruptive medicine”, Mayo Clinic has introduced the fictional characters, Susan and John.(4) I urge you to meet them and consider their alternate pathway. But more importantly, I urge you to register and listen to Thursday’s WIHI program.(1)

“Minimally disruptive care” probably doesn’t go far enough, but coming as it does from the seat of Academic Medicine, it’s a step in the right direction.

For Health Commentary, I’m Mike Magee.

References:

1. WIHI. “Minimally Disruptive Medicine”. August 9, 2012. 2:00 – 3:00 PM EasternTime.
http://www.ihi.org/offerings/VirtualPrograms/WIHI/MinimallyDisruptiveMedicine/Pages/default.aspx

2. May C., Montori VM, Mair FS.We need minimally disruptive medicine.BMJ 2009; 339 doi: 10.1136/bmj.b2803 (Published 11 August 2009)Cite this as: BMJ 2009;339:b2803
http://www.bmj.com/content/339/bmj.b2803.full?ijkey=GrnqZhD5tbhn2VA&keytype=ref

3. IHI 13th Annual International Summit. Washington,DC.
http://app.ihi.org/marketing/program_documents/2012_IntlSummit/2012_International_Summit_Conference_Guide.pdf

4. Verdoorn A. Minimally Disruptive Medicine. Mayo Clinic.
http://minimallydisruptivemedicine.org/2012/01/10/minimally-disruptive-medicine-comes-alive/