I once had a patient with HIV who refused to take his medication. His noncompliance was not because he lacked information about his illness or because he didn’t understand why it was important to take his medications. He knew full well that he would die without taking them.
After doing a little digging, I learned that the reason was personal. He was afraid to tell his partner about his diagnosis. Not only was he afraid to admit that he had been unfaithful, he worried that his partner would leave him. My experience with this patient was a valuable lesson for me that medicine is not what I thought it was.
I realized that the practice of medicine is not just about a series of clinical decisions based on evidence-based practices. It is also about helping people to change their behaviors, whether they need to take their meds, lose weight, or quit smoking. If we want to achieve optimal outcomes, then it is part of our job as care providers to help people identify and address personal barriers to healthy behavior change.
It seems many of us have some preconceived ideas of what new Medicaid members will look like: They’ll be older, sicker, higher utilizers of services and, more challenging to care for.
But when we take a closer look at populations that will qualify for Medicaid over the next several years, a different picture appears. Chances are the new Medicaid member is going to be that part-time waiter at your favorite local restaurant or the young woman with a toddler and another on the way who decided to go back to school.
I saw my doctor last month for an annual physical. I cannot imagine a better primary care physician; he’s so thorough, so kind. After an exhaustive review, he said all seemed pretty much “ship shape,” but he had to add one dig: “Hey, I was glad to hear you finally went for your screening colonoscopy. Thing is … I can’t find any evidence that it actually happened. No claim, no entry into the electronic medical record, nothing. Did you end up having the procedure?”