*Catastrophic Care*: Chapter 10

Patients increasingly have access to websites designed for providers and other health care professionals. The NNT (which stands for “number needed to treat”) is a particularly valuable corrective to much medical information, reversing the perspective on treatment efficacy that patients usually get in health care advertisements. For example, the site will translate a pharmaceutical company’s technically correct claim that its drug reduces the risk of a specific illness by 40 percent into a more meaningful fact: a hundred patients will have to be treated with the drug before a single patient can expect to benefit.

Quoting this passage from chapter 10 of Catastrophic Care gives me the opportunity to do three things.

  1. Here’s the link to The NNT. And, Goldhill is right to hype it. It’s very good.
  2. One of the creators and champions of The NNT is David Newman. I’ve mentioned him before. He also wrote a book about evidence-based medicine for a lay audience: Hippocrates’ Shadow. I recommend it.
  3. In my first post on Catastrophic Care, I made two stylized points about the health system: (i) It’s not responsive to consumers. (ii) It’s not responsive to evidence. I can understand how patient control of payment — Goldhill’s thrust — could address the first of these. I’m far less convinced it can do very much about the second. After all, patient satisfaction and clinical quality are two different things. It does not surprise me at all that patients can be subjectively happy with objectively bad care. A good bedside manner and attention to amenities and convenience go a long way. Patients deserve that. But they deserve good clinical quality too. If they can’t judge it, I’m not convinced they’ll buy it. In fact, I’m more convinced they’ll buy something that makes them feel good in the moment even if it they know it’s not objectively better. Americans (probably all humans) buy a lot of stuff that’s of low quality or even bad for them, but makes them feel good right now. That doesn’t matter a great deal if the product is a movie or a dinner or a clock radio (though, to those with modest resources, yes, it does matter). But it does matter a great deal if the product is a diagnosis or a cardiac procedure. This is not an argument for the status quo, merely an argument to be cautious about the benefits and realistic about the limitations of patient control of payment.

Other posts about Catastrophic Care are book here.


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