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| Give a man a fish, or teach him to fish. |
It is a well known secret in medicine: many of those we care for are unconcerned with their own care, as evidenced by their revealed preferences. "What medications are you on?" the physician asks. "I don't know, doc," comes the reply. "Why are you on carvedilol?" "I don't know." "What was your last HgbA1C?" "What's that?" We have encouraged physicians and other professionals in the healthcare system to take responsibility for every aspect of patient's care to the peril of patients' own interest and investment in their care. How often do you enter a room and find a patient researching their illness and its treatment, rather than surfing the internet or watching TV? Is your patient more concerned with the timing of the next dose of antibiotic or the next dose of dilaudid? How often do your patients keep detailed records of their past medical history? Why does the intern or resident or PA or NP schedule follow-up appointments for patients, rather than the patients do it themselves prior to discharge? Why must so many patients be coaxed out of bed and working with physical therapy? The actions of patients reveal their preferences. Those who are invested in their own care take responsibility for it and are knowledgeable. Those who would rather watch television than work with physical therapy reveal other priorities and preferences.
All the hubbub about healthcare and health disparities has entirely glossed over the role of personal responsibility and accountability in medicine. Some may find it inexcusable that many patients have so little investment in their own health care, expecting instead that the government, their insurance company, and the healthcare system at large allows them to abdicate their own personal responsibility without consequences.
(I am not here referring to people who are unable to care for themselves, but rather those who are perfectly capable but who shirk the responsibilities. If you cannot accept this and wish to accuse the author of "blaming the victim" read no further. Yes, the victim of disease is being blamed for any lack of personal responsibility that is contributing to poor health.)
If there is a lack of personal responsibility in medicine, there are several important implications that we should be concerned about.
