Wendy Lynch, Ph.D.You knew it was coming. Reality TV has come to health care.

WDEY network began filming a new reality show last month; it’s called Medicine Unlocked (1). It follows real patients navigating the health care system in search of treatment for their ailments. Each two-hour episode focuses on four patients who share a specific preliminary diagnosis; one week it’s back pain, another it may be gall bladder problems or men with suggested prostate cancer. Each patient-contestant receives a pre-loaded health savings account and debit card and earns “keys” that allow passage through a series of decision “gates.” Gate 1 is Who (will be their doctor); Gate 2 is What (confirming their diagnosis); Gate 3 is How (the problem will be treated); and Gate 4 is Where (the treatment will occur). By successfully getting through the gates to a successful treatment, patients become eligible for a $1 million grand prize.

The reason this is a reality show rather than a documentary is that the Who, What and How gates consists of a choice among three options. Two options are real, one is fictional. As an example, in the arthritis episode, a pretend bone-specialist convinces one patient that a new nano-Teflon coating can be applied to his knee with a robotic needle at half the price of knee replacement. For gallstones, a radiologist explains how the small dots on the image were actually undigested items blocking her bile duct (“tell me, have you ever swallowed your gum in the past, Mrs. Jefferson?”).

Operating Surgeons

If the patient selects a real option, he or she pays the cost of the option, gets a key and passes through the gate. If the patient chooses the phony option, he or she must pay a stiff penalty, and choose a new, non-sham treatment to get their key. Expert judges comment on the contestants’ choices and what they might have done differently. Not surprisingly, they don’t all agree.

For the final Where gate, things get even more challenging. Patients select from three treatment locations (all real). To earn the final gold key, they must not only select the facility they want to use, but also rank order the facilities by their safety ranking (1st, 2nd, 3rd) and by cost of the surgery (1st, 2nd, 3rd). They only have four hours to investigate using whatever online or phone or other resources they want. The ultimate winner is the contestant with enough money left in the health savings account to get the treatment, who correctly ranks the greatest number of facilities. While six out of six correct rankings gives them $1M eligibility, TV viewers get the last word as they choose their favorite among the qualifiers.

If you are like me, you won’t know whether to be impressed or appalled by this series. Useful, teachable moments occur at every gate. The viewing public sees first-hand the disturbing level of uncertainty, inconsistency, and misinformation faced by almost every patient. However, the authentic pain and emotion borders on exploitation. The detailed discussion of the potential consequences facing one prostate cancer patient (impotence, incontinence) will leave a pit in most viewers’ stomachs. And, without spoiling the story, there is one tragic result in a mid-season episode.

Maybe we need a show like this.

For readers who haven’t looked at the references yet, there is no reality show, except in my imagination. But the more I learn about the gap between what consumers know and care about, and what the experts say about quality and safety, the more I daydream (obviously) about ways to shift popular culture to prompt more active questioning of the safety, quality, and cost of health care.

It’s not a coincidence that the reality show idea coincides with this week’s release of our latest consumer survey results. Some trends are encouraging. The majority of respondents reported wanting to play a primary role in making decisions. Younger consumers report asking about cost and quality more often. When choosing a hospital for surgery, consumers rate safety and experience as most important.

On the other hand, other areas reveal a great opportunity for building awareness. To name a few:

  • Consumers still rely most heavily on the advice of family and friends for selecting a doctor.
  • More than half of the population has never asked about price before getting a medical service.
  • Two-thirds are not confident that they can get lower-cost care by shopping around.
  • Consumers rate convenience and bedside manner above quality measures in importance for selecting a doctor.

One can interpret these findings in several ways. Some have suggested to me that many consumers do not have the interest or the ability to be involved in decisions about care. Some say it is a generational bias reflecting our parents’ experience that “doctors know best.”  While these explanations may have elements of truth, my sense is that the general public has simply lacked reasons to pay attention and examples to emulate. It is more reassuring to think of medicine as concrete, scientific, and altruistic than to acknowledge its inherent risk, fallibility, and perverse business incentives. So, most depictions of medicine have heroes and affordable, happy endings.

While we can hope our health care industry will promote consumer involvement in decisions through education and transparency, it may take a more disruptive intervention to shift perceptions.

Anyone want to volunteer for Season 1?

References

  1.  WDEY stands for “We Don’t Exist Yet.”  The show does not exist. I dreamed it up.

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Wendy Lynch, Ph.D. is the Director of the Altarum Center for Consumer Choice in Health Care. This post was originally published on the Altarum Institute Health Policy Forum.

 

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