A call for "minimally disruptive medicine"

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In the BMJ, professors Carl May, Victor Montori, and Frances Mair write: "Chronic disease is the great epidemic of our times, but the strategies we have developed to manage it have created a growing burden for patients. This treatment burden induces poor adherence, wasted resources, and poor outcomes. Against this background, we call for minimally disruptive medicine that seeks to tailor treatment regimens to the realities of the daily lives of patients. Such an approach could greatly improve the care and quality of life for patients."

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As I read this thoughtful and likely provocative article, I reflected on the fact that I have had the opportunity to speak with and learn from two of the authors--Carl May and Victor Montori--and am not surprised at the insights and wisdom offered.

In fact, my past exposure with Carl has been on his Normalization Process Method (Normative process) model, which addresses the challenges and needs to incorporate a new technology or complex intervention into the health care arena. He speaks of needing to move beyond adoption (guaranteed to cause yawning among many of those within your organization), and implementation (with it's specific approaches and focused efforts) to understanding normalization--what needs to be in place, functioning, and accepted by all--to ensure that a new intervention is a "normal" part of the work flow.

Intuitively, this article on "minimally disruptive medicine" to my linking type of mind, expounds a similar concept to facilitate enabling our patients to be "compliant" and "adherent" to our recommendations. Asking for changes in behaviors and life styles whichare at odds or in conflict with their present practices is a recipe that allows we clinicians to point our finger and use the 'non-compliant" term in describing their failure to adhere to our wonderfully crafted recommendations.

I've had conversations with Carl regarding the application of his concepts to our work at the Institute for Clinical Systems Improvement,specifically our depression project (DIAMOND) in ensuring it becomes a part of our usual practice, not a separate special effort, requiring extra work. This article compels me to further my thinking in moving that forward. Thanks for a thoughtful, contemplative, and hopefully provocative piece.

About this Entry

This page contains a single entry by Gary Schwitzer published on August 12, 2009 11:42 AM.

WH press secretary scolds journos on "noise" reporting on health care reform was the previous entry in this blog.

Bioethicists speak out on health care reform myths, calling the current state of health care unethical is the next entry in this blog.

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