Patient perceptions of barriers to effective migraine management in Aotearoa New Zealand, 2024, McInnarney et al.

Patient perceptions of barriers to effective migraine management in Aotearoa New Zealand
Blair McInnarney; Fiona Imlach; Jonathan Kennedy; Susan M. Garrett

INTRODUCTION
Migraine is a complex neurological condition which requires evidence based treatment, tailored to the individual. International evidence shows that treatment is often sub-optimal, but the experience of people with migraine in NZ is unknown.

AIMS
This study aimed to describe the barriers people with migraine disease face when seeking care for their condition in Aotearoa New Zealand (NZ).

METHODS
The Migraine in Aotearoa New Zealand Survey (MiANZ) was delivered online via SurveyMonkey from 22 August 2022 to 7 October 2022. Questions included: sociodemographics, the Migraine Disability Assessment Scale (MIDAS), ability to access health care, perception of health professionals’ knowledge and open-ended questions. Analysis used a mixed method approach.

RESULTS
Five hundred and thirty people from NZ responded, of whom 82% (433/530) were female and 77% (409/530) NZ European/other. Eighty-eight percent (467/530) had accessed primary care for migraine, with 36% (167/467) finding GPs’ knowledge of migraine to be excellent or very good. Forty-two percent (222/530) reported at least one instance where they had felt judged because of migraine by a health professional. Themes from free-text data included patient perception of health professionals’ knowledge of migraine, the presence of stigma within medical practice and systemic barriers to accessing effective health care.

DISCUSSION
People with migraine in NZ report significant barriers when trying to access effective management. Barriers were in both primary and secondary care and impacted the ability of people with migraine to manage their condition. More current migraine continuing medical education for GPs and other health professionals, better development and communication of care plans between primary and secondary care and patients and measures to address stigma are required to improve management of this complex disease.

Link | PDF (Journal of Primary Health Care) [Open Access]

 

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The same problem is found in almost all health problems. So are they going to do more training on all those conditions? No one is ever going to understand all diseases, so advising training on all conditions is delusional. This isn't the way to address this, it's not even close to be realistic. Might as well advise to have angels take up the slack.

There are reasons why this happens. Almost always it's the same process: MDs ignore patient reports, downplay symptoms and psychologize problems, seemingly believing that their job stops at looking for deadly diseases and reassuring patients when they don't seem to have one, and more often than not don't even have the time anyway.

Unless the underlying reasons are addressed, this makes zero sense. You have to address root causes. Why doesn't medicine do root cause analyses? This is how you solve core problems, it's highly effective in all engineering fields. But instead we have this piecemeal and wildly redundant isolated take on each individual problem, all finding the same issues and all concluding the same way: more training for this specific condition. Nothing ever connects the dots, everyone is always looking at one question and spits out one answer, regardless of whether either have anything to do with the problem.

Medicine seems incapable of self-correcting. It's impossible to ignore it at this point. Things are so bad that I pretty much assume than in most conditions, AI models would already do better because of this alone, but there is no way to verify because the only valid comparisons would be with a system that currently fails at it. The simple fact of there being no limits on time and number of patients probably far outweighs better ability to diagnose in the best circumstances, which are usually the exception.

Once AI medicine takes off it's going to be shocking how many systemic problems it will expose. It will be like lighting up a room that was only ever looked at with tiny flashlights.