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Patients must demand better care So says health care advocate David Lansky, who spoke Monday in Medford By DAVID PRESZLER The consumer is king in America -- except at the doctor's office and the hospital. And that, according to health-care quality activist David Lansky, is a big part of the problem with the current system. "The only people that will adamantly push for better care is the public," Lansky said Monday at the Chamber of Medford/Jackson County's monthly forum. He quoted a survey from the American Medical Association that found 42 percent of Americans believe they have been victims of a medical error. Lansky, president of the Portland-based Foundation for Accountability, believes consumers should demand more from doctors, hospitals and health plans. He pointed to disparities in the type and quality of care from place to place as symptoms of a system gone awry. While many believe health-care practices and quality are the same everywhere, he said research has shown that's not the case. For example, a study of breast-cancer treatment practices found that women treated in one city were four times more likely to have a mastectomy than those treated in another city, where breast-conserving surgery was more common. Less dramatic variances can be found throughout the country, he said. For example, Medford has a higher rate of back surgeries among Medicare patients than the national average. Lansky didn't provide clear explanations for such variances but said they underscore the need for more accountability within the system. He was careful to aim his criticism and concerns more at the system than the motives of health care providers. "There's no one in particular to blame for this," he said. "The intention is excellent, the execution is terribly faulty." The problem, he said, is that the current system doesn't adequately reward efficient and high-quality care, which can lead to unnecessary treatments. "The doctors get paid more for doing more things," he said. "People aren't rewarded for doing better work, they are rewarded for doing more." Lansky said patients need to think more like consumers, taking on the responsibility of becoming educated shoppers. They need to realize that quality matters, that quality varies, that quality can improve and that people can make a difference by understanding what quality care is. To do this, he proposes a model for evaluating what patients expect and should expect. That way, consumers can make better decisions about where to get quality care -- thus putting pressure on providers to make sure they are supplying it. Local health-care providers at Monday's presentation said they approve of patients taking an active role in their health care. "We welcome consumer input and involvement in what we do," said Steve Lilley, vice president of Asante Health System. "We feel that we strive to do that. He's not proposing anything we'd be opposed to." Lilley and Nancy Roberts, coordinator for physicians services for Providence Health System, pointed to efforts by local hospitals to provide health information to patients and to encourage them to take an active role. "Clearly now, the consumer wants to take responsibility," said Roberts. But the effort to make that happen is just beginning, Lilley and Roberts said. "You need to begin the dialogue. It takes a lot of wisdom to be open to change." Mail Tribune Copyright � The Mail Tribune 1999, Medford, Oregon USA