Re: “How U.S. Health Care Came to Cost Insanely More” by Joe Flower in H&HN Daily, May 19

Thanks, Joe, for showing us a dramatic illustration of the way unintended consequences have resulted from efforts to legislate or regulate control. I offer another related example. As a hospital architect, I watched client after client resist the intent of certificate of need legislation in 1973. If it might be denied, they chose to apply and fight for it as soon as possible,

resulting in more, not less, expensive high-tech projects. They were afraid such projects might be blocked if they didn't move quickly.

The same thing happened with the imposition of DRGs and the numerous ways organizations worked to circumvent the limits. When New York had a four-year moratorium on hospital construction, it was immediately followed by a flood of larger-than-ever projects, satisfying the pent-up demand that might have been resolved at less cost if it had been addressed incrementally over the intervening years. When Texas sunset its CON legislation, most organizations returned to responsible, conservative decision-making about capital projects. It was the threat of denying growth or technological upgrades that seemed to drive the push to acquire as much as possible as soon as possible.

It is human nature to want what we are told we can't have.

— Kirk Hamilton

Why 'Consumer' is the Right Term

Re: “Whom Does Health Care Serve: Patients, Consumers or People?” by Kenneth Kaufman in H&HN Daily, April 28

There is no pure corollary; another approximation, and one perhaps closer to the doctor-person relationship is the power dynamic involved when someone needs professional services — attorney, plumber or shoe repair. The need for professional services doesn't involve health, but is created by a need that is stronger than going to a store for paper towels.

The reason “consumer” comes closest to describing the new role people have been forced to adopt or consider is that there isn't just a greater amount of decision-making that individuals have available to them, it's that they're being forced to accept more responsibility for their decisions as well. There is greater financial exposure, greater autonomy in the range of options, less protection from employers, more process constraints, and more ongoing feedback about the consequences of deferring action on living a healthier lifestyle. Add the democratization of information on the Internet, and more of the power dynamics add up to the person being a “consumer” than a patient.

It seems fair to acknowledge that moving from consumer to patient is a process, a change of power dynamic and identity that is deeply significant. I see nothing wrong with an increasingly retailized system according consumers the respect they receive from other marketplace sectors, while shifting to a more protective stance if they choose (or are forced) to become patients.

— Stephen Bolles

Restoring Clinicians' Joy

Re: “The Importance of Preventing Burnout Among Physicians and Nurses” by Bridget Duffy, M.D., in H&HN Daily, May 21

Wow, great article. The best line, for me, was "restoring joy to the practice of medicine." What a lovely image! I do agree with this article's proposition of the quadruple aim ... what a great idea.

I also thought it interesting that the author brings up technology. It's so true that sometimes the things that make our lives easier invite unintended side effects. However, when we can find creative ways to learn from experiences and explore innovative shifts, I find these advances to be a win for all. Sharing this great article with my tribe, thank you!

— Elizabeth Scala

The Consequences of Burnout

Re: “The Importance of Preventing Burnout Among Physicians and Nurses” by Bridget Duffy, M.D., in H&HN Daily, May 21

Excellent observations, Dr. Duffy. When people feel less positively or less well-connected to their work with others, it should not surprise us if the outcomes from that work are suboptimal or if those doing the work end up seeking to stop doing it.

— Richard J. Bogue