Supervising Adults

Kel Mohror

Dr. Michael Koriwchak, in a October 5, 2012 blog post titled "The Naiveté of mHealth," describes a situation where mHealth fails utterly in the post-hospitalization care of a congestive heart failure (CHF) patient.

Our CHF patient is discharged from the hospital all tuned up with appropriate medications, diet and smart phone remote monitoring using a CHF app.  The monitoring app works well at first, feeding him periodic words of encouragement and reminders to take his meds, record his vital signs, weigh himself, etc. 

After several days of his phone going off constantly with all the reminders, alert fatigue sets in.   After ignoring the alarms for a few days he gets fed up and shuts the CHF application
off.  The monitoring network detects the data interruption, and a provider calls the patient. At first the contact with a real human helps, but after several calls alert fatigue strikes again. Our patient recognizes the caller ID and stops answering.

 In the meantime he tires of his medication regimen and diet restrictions and succumbs to the urge to scarf down some pizza and beer with some potato chips for dessert.  His smart phone isn't smart enough to change his behavior. The salt and fluid load makes his heart failure worse. In the middle of the night he wakes up short of breath and calls 911.  Back to the hospital he goes.

I wonder at what point do we, as a society, regain expectations of accepting the consequences of ignorance? When "adult supervision" of adults becomes standard practice in many walks of life such as healthcare or teaching (where a teacher bullies a teenager for wearing a political tee-shirt which the teacher likens to the KKK!), those being supervised cannot be coddled, but rather must be penalized. 

Whether the consequence is termination of vocation or of life, that is what the teacher or patient chose, knowing full-well what her / his behavior could lead to.

If a patient, upon leaving the hospital "all tuned up with appropriate medications, diet and smart phone remote monitoring using a CHF app," chooses to behave in ways that surely put her / him on the path to readmission, perhaps the re-admit should be denied.

If a patient prefers foods and sedentary ways over "field-proven" discharge instructions, why should the medical and nursing knowledge, expertise, time and hospital resources be wasted on a re-admit who clearly chooses comfort and what is easy over what is "medically necessary" to live? Can't those professional and material resouces be better used for healing a similar patient who "lives" the discharge guidance and regains health over time?

Choosing to ignore "the rules" has consequences- a speeding ticket and higher insurance costs, an accident from "running" a red light, and higher morbidity due to "not liking" the therapeutic regimen.

 Society can no longer afford to reward unhealthy behaviors with "do whatever it takes" healthcare.

Comments

[Jonena Relth]

Hi Mel,
Wow, you're on a roll with this one and I'm guessing will bring some negative reponses. While intellectually we might agree with you, our hearts just aren't there yet.

As Forest Gumph said, "Stupid is as stupid does." And yet, life went on!

Americans are too used to being spoon-fed information, medical care, etc. We're just not where we should be as a nation.

[Matthew R Giese]

Thanks for this post. I don’t know a large number of links to forums but my friends seem to be able to spend a lot of time on them that’s for sure.

[Health Insurance]

Thanks for the heart touching blog, patients should be taken seriously and mental care always should be provided to them.

[Medication Management Systems]

This is a great post, and I think you've made an interesting argument. I do, however, want to counteract it a bit. I agree that people need to be held accountable for their own health and the actions they take to maintain it; however, I do think that people often leave facilities or doctor's offices misinformed or undereducated about their own health. Perhaps, what is needed is monitored transition from a facility medication management system to an individualized system.

[Jonena Relth]

Medication Management Systems,
You might be on to something here. Adult learning theory shows us that adults learn according to their personal learning styles, and repetition and followup are key to our remembering new or stressfull information. I'd like to see what you have in mind.