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“One strategy that’s not recommended is to yell at your patients,” says Dr. Victor Montori.

Courtesy Mayo Clinic,

Less medicine for overwhelmed patients

  • Article by: Maura Lerner
  • Star Tribune
  • May 13, 2013 - 9:31 AM

It’s hard enough to live with a chronic condition like diabetes, says Dr. Victor Montori of the Mayo Clinic. But sometimes doctors make it harder, by piling on more tests and treatments than the patient can bear.

In an era of checklist medicine, Montori is trying to push the pause button. He believes that, before doctors pull out their prescription pads, they should have a heart-to-heart talk with patients who have complex conditions about how much medicine they really want to put up with.

Montori, 43, has become an evangelist for what he calls Minimally Disruptive Medicine — also known as Goldilocks Medicine (not too much, not too little). Last week, he took his message to a health conference sponsored by Minnesota’s Institute for Clinical Systems Improvement, calling for a revolution of sorts to reduce “the health care footprint on people’s lives.”

A common theme at conferences like this is how to get patients to comply with medical advice — especially now, when many doctors are rated on how well patients control their blood pressure or blood sugar. The problem, Montori says, is that this approach risks turning doctors and patients into adversaries.

“One strategy that’s not recommended is to yell at your patients,” quips Montori, a telegenic diabetes specialist from Peru. “If you threaten a patient, the patient may run away.”

In fact, many patients already practice passive resistance: not filling prescriptions, or leaving their pill bottles untouched. It becomes a vicious cycle, Montori says: Patients feel overwhelmed, their condition gets worse, so the doctor orders more tests and treatments, making them even more overwhelmed.

He argues that doctors must take into account the patients’ “values and preferences.” If one drug can bring their blood sugar down a notch, but doesn’t make them feel better, is it worth taking? “It’s making sure we don’t make any decisions about them without them,” he said. It’s a strategy that stops demanding perfection from patients and focuses on the treatments that are most important to them. “So they only get what they need and what they want.”

In the future, he says, he hopes there’s less focus on whether patients hit a specific blood-sugar target, and more on what he calls their functional capacity.

“Are they able to do what they want to do and need to do with the least possible limitations?”

 

maura.lerner@startribune.com

Watch a video

of Montori on Minimally Disruptive Medicine, at www.startribune.com/a2237.

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