Why Isn’t Your Treatment Working?
In the previous post in this series we walked you through the first of five clinical features that can serve as a reasonable proxy measure of a consultation’s value. It related to the extent to which your practitioner has taken steps to educate you about your condition’s natural history.
“If your provider has not explained to you how your condition will (or will not) improve in the absence of treatment, you are receiving low value care and would be better served elsewhere.”
In this post, we consider the next of our five indicators of high value care- failure to outline a timeframe over which treatment is expected to expedite your recovery above and beyond you condition’s natural history. Some injuries or pain problems have a very rapid natural history, and arguably don’t require much in the way of treatment in order for you to make a full recovery. Other injuries or pain problems can take months, or even years to make a full recovery. While there are still other conditions for which there is no “cure” as such, where optimal care is arguably more about controlling symptoms with a comprehensive, long term management plan than it is about resolving symptoms. This should give you pause for thought. What is the nature of your condition? Is it realistic to expect a proposed treatment to resolve the symptoms of your condition? Have you been led to believe that your problem is resolvable? And how much treatment will be needed? Or is it your understanding that your condition is one that must be managed with ongoing treatment? Have you been given a long-term prognosis by your provider? If not, by what standard could you possibly measure your recovery (or lack thereof) against? And without such a point of reference, how could you possibly assess the quality of a service provided?
Interestingly, as far as the sorts of musculoskeletal injuries and pain disorders that are managed in a typical private practice setting are concerned, injuries and pain problems with extremely poor prognoses are very rare. How then, should you interpret minimal improvements (or the absence of improvement) in response to a course of treatment? Would it make sense to assume that the treatment received has been appropriate, but that the severity of your condition, or perhaps your failure to adhere to the “homework” your provider prescribed for you is/was the reason for an absence of improvement? It might be tempting, particularly if you have a good rapport with your provider, to blame these factors rather than face the idea that the treatment you have engaged in simply isn’t working. Perhaps the truth though, is that the absence of a favourable response to treatment simply reflects the prescription of inappropriate or ineffective treatment.
The fact that conditions with poor long-term prognoses are a rarity in a typical private practice setting would suggest that very often, an absence of improvement is indicative of the prescription of ineffective treatment. But as a patient, how would you know? What information would you need to make a judgement? Would it not help if from the outset, your provider outlined a timeline over which a proposed treatment plan was expected to expedite your recovery above and beyond your condition’s natural history? Wouldn’t such an outline provide you with an objective measure against which you could hold your provider to account? Would there be value in a plan of care that stopped short of including such an outline? It’s our view that in addition to providing you with an understanding of your condition’s natural history, a truly high value provider will also outline a timeline over which a proposed treatment plan is expected to expedite your recovery above and beyond your condition’s natural history. If you haven’t received such an outline from your provider, it is fair to conclude that you could receive higher value care elsewhere.
“… a provider should outline a timeline over which a proposed treatment plan is expected to expedite your recovery above and beyond your condition’s natural history.”
In the next post in this series, we will look at the third of five indicators of consultation’s value.
(side bar: How is it that misinformation from practitioner to patient is even a problem? Aren’t healthcare providers highly trained, highly educated individuals with all the latest and greatest information at their fingertips? To read about how practitioners can become misinformed, have a read of this post)