Map of life expectancy at birth from Global Education Project.

Monday, April 09, 2007

A couple of observations from work in progress

You aren't supposed to say too much publicly about research that hasn't been completed, but I think it's okay for me to talk here about some informal observations and hypotheses that are coming out of work I'm doing now. This involves a method for coding and analyzing physician-patient interactions. I believe I've alluded to it in the past but I'm not going to search for it right now.

The key point is that our new method lets us separate out what the people are talking about from how they are talking about it. It turns out that if you give physicians independent information about how well their patients are adhering to a medication regimen -- based on a device that records when pill bottles are opened, for example -- the doctors generally end up spending more time talking with the patients about adherence. The bad news is -- and I'm sure this will come as no surprise to our friend Dr. Showalter -- this doesn't have any discernible effect on how well the patients adhere. They have the conversation, but they just go on not taking their pills.

Another disappointement? Well, yes, but also maybe a clue toward a more productive path. Most of this additional talk is more or less like most of the adult voices on South Park -- a lot of scolding noises. It's take your pills, you have to take them on time, if you don't take your pills bad things will happen to you, why don't you take your pills, I'm telling you to take the pills, you must take the pills, yadda yadda yadda. I expect it turns into "meepmeepmeepmeepmeep" in the listener's cortex and that's all it's worth. What you don't get is a talk with Chef -- what is the problem and how can we solve it?

As I said in one of the interesting background conversations that are going on regarding this topic, people who don't "adhere" aren't generally being "irrational." It's just that they aren't investing all their effort into maximizing their acturial expectation for Quality Adjusted Life Years. People's self-adjustment for their own quality of life includes items like not having to deal with the constant hassles of refilling prescriptions and remembering to take pills that remind them that there is supposedly something wrong with them; not having to pay $45 in copayments every month; not having to explain to co-workers (or their kids) why they are taking an anti-retroviral at 2:00 every afternoon; and so forth.

Doctors get frustrated when their patients don't comply but if they want to do something about it, I suspect it would help if they would learn to listen more and talk less. I can't prove that yet -- but it's worth investigating.

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