“Empowered and Responsible” vs. “Non-compliant” Patients:
A parable about a physician, a rock, a bird and a target,as told by Douglas Eby, M.D.,
Vice President of Medical Services at Southcentral Foundation in Alaska.
5 min. 13 secs into Rx: The Quiet Revolution
If you have a target on the wall and what you have in your hand is a rock, you can throw the rock at the target. Eventually, through practice, you can make the rock hit the target every time. I am active. The rock is passive. I exert my will on the rock and make it do what I want which is to hit the target.
But if I have in my hand a bird and the goal is for the bird to be at the target, I can push the bird with some force, I can aim it and push it toward the target but whether the bird ends up at the target is almost completely dependent upon whether the bird decides to fly to the target or not. Now, if I put a bird house and some bird feed and its bird babies on the target, it is way more likely that the bird will actually go to the target. Why? Because I spent time understanding what is important to the bird. And I put things that are value to the bird at the target that the bird cared about.
This is healthcare. People are more like birds than rocks. They have will. They make their own decisions. My job is to influence the bird or the person to get to the target.
More Like Birds than Rocks, SUSAN CARR, Editor, “Patient Safety and Quality Healthcare”
At the beginning of the film, Rx: The Quiet Revolution, Doug Eby, MD, vice president of medical services at Southcentral Foundation in Alaska, tells a parable about a physician, a rock, a bird, and a target painted on a wall. If the physician throws the rock at the target, eventually, with practice, determination, and perhaps some luck, he will hit the bullseye. If the physician has a bird in his hand, he can aim and nudge it toward the target, but only the bird can decide to land on it. The physician can further influence the bird by making sure the target is relevant and valuable, but in the end, it’s up to the bird.
Eby points out, “This is healthcare; people are more like birds than rocks.” Physicians can teach, coach, and persuade, but ultimately, patients are in control of their own healthcare decisions. The physician’s effectiveness and the health of patients and communities depend in large part on the quality of relationships and how people feel about themselves and each other.
See also beginning at 1:05:09 into the film, Rx: The Quiet Revolution a segment about patient compliance (or non-compliance) with the prescribed medication regimen.
Our complicated treatment and medication plans “are only going to be effective if the people we serve are fully engaged and committed to acting on them.”
And also see: Rushika Fernandopulle, M.D. Pay Now, Live Longer…
1 min 32 secs. into the YouTube video:
Under the IORA Healthcare model, drug costs actually were up a bit because patients actually take their medications. Our fill rate at the pharmacy was 98.8%. Most doctors don’t have the foggiest idea of what their fill rate is but it is a lot less than 98.8%. Usually it is in the 70 – 80 percent range when people look.