Health Care Hotspotting — A Randomized, Controlled Trial (2020) Finkelstein et al

Hoopoe

Hoopoe

Senior Member (Voting Rights)
A program developed to reduce healthcare utilization by "superutilizers" failed to show any effect on healthcare utilization.

https://www.nejm.org/doi/full/10.1056/NEJMsa1906848

This may be of interest to readers here because this was a behavioural health approach that involves searching for patterns in healthcare utilization data and using what they call motivational interviewing, trauma-informed care, accompaniment, harm reduction to try and get patients to seek help less often.

Theme one is trauma-informed care. Trauma, especially early childhood trauma, can affect health and drive puzzling and off-putting behavior from patients. Understanding trauma-informed care is essential for working with this population.

Theme two is the need for a harm reduction mindset. Often patient’s lifestyle choices challenge our personal morality or seem simply self-destructive. We approach our patients with the mindset that change is difficult and the most important short-term goal is to reduce the negative impact of certain behaviors on health, not to attempt to force complete behavior change.

Theme three is the value of motivational interviewing. A mantra in our work is we don’t know what we don’t know. Approaching patients with open-ended questions can elicit revealing information and build trust and understanding. Active listening, goal-setting and accountability are the foundations of supporting behavior change.

Theme four is the importance of setting boundaries. Health care providers are usually deeply caring people, and working with individuals in pain and in need of help is emotionally and intellectually taxing. Setting and maintaining appropriate emotional boundaries between you and the patient is important both for the patient’s self-empowerment and for the self-care of the provider.
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https://hotspotting.camdenhealth.org/patient-case-studies/
 
Theme four is the importance of setting boundaries. Health care providers are usually deeply caring people, and working with individuals in pain and in need of help is emotionally and intellectually taxing. Setting and maintaining appropriate emotional boundaries between you and the patient is important both for the patient’s self-empowerment and for the self-care of the provider.

Do I get a sense that the clinical psychology profession is beginning to realise that the whole thing was a dreadful mistake and that being a clinical psychologist can seriously damage your health?

Is it that these Boston psychologists are beginning to realise that they may have spread the illness of bing a clinical psychologist all over the USA and caused all sorts of harm?

There is a peculiar sort of death wish aspect to this paper.
 
Another great example of FAES (false attribution error syndrome) where physicians are utterly puzzled by patient behavior they do not understand and choose to attribute this behavior based on their own personal perception and beliefs. They keep refusing what patients are telling them as invalid and don't even seem able to entertain the notion that they could be wrong about that. Just incredible. It's really a blessing that the rest of science doesn't work that way or we'd be totally screwed as a species.

Reading this almost hurts, the lack of self-awareness almost makes a tree look enlightened:
A mantra in our work is we don’t know what we don’t know.
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Then quit making stuff up as a substitute for what "those patients" are consistently telling you. It serves no purpose whatsoever. The foundational model of MUS is literally giving made-up explanations for the unexplained. It's the basis of the whole damn thing for the last several decades and despite abysmal failure in practice.

Really reminds me of people trying to turn carnivore animals vegan who are so utterly puzzled when in a blind test the animal always chooses the meat even though in their carefully controlled cherry-picked setting it seemed to work. There is just a fundamental split in understanding that makes the spin in place while marveling at how much distance they're covering in a circle.
 
rvallee said:
The foundational model of MUS is literally giving made-up explanations for the unexplained.
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In 1976, a young doctor perched on the end of my hospital bed after a week of tests, looked me in the eye, and said, 'I can see you're really unwell, but I'm sorry, I can't work out what's causing it.'

It's depressing to think that he probably got sucked into the medical machine, where acknowledging someone's illness but admitting you don't understand it is highly detrimental to your prospects. It sometimes feels as if he's the only person who's ever really told me the truth; I guess I'm just lucky I saw him when he was still at the beginning of his career!
 
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