Let's Stop Healthcaresplaining

You've probably heard of "mansplaining," usually used to describe men explaining something to women in a condescending and/overconfident manner, and often on a topic that the woman knows more about than that man.  Well, healthcare has its own version of that, which I'm calling "healthcaresplaining."

 Healthcare (and health) is complicated.  Healthcare can often be confusing, even scary.  Life and death decisions sometimes have to be made in milliseconds, with no time for discussion or debate.   All those are reasons why many -- especially healthcare professionals -- are adamant that patients aren't and never will be "consumers." 

That's an example of healthcaresplaining. 

The 21st century is a complicated time.  We are surrounded by, and dependent on, technology that we don't really understand and that most of us would be at a loss to repair.  That's why we have the Genius Bar and the Geek Squad. 

It's not just the technology; many aspects of our lives are based on rules and processes that we also don't understand.  As a result, we delegate many of those aspects to "experts."  Something is gained, to be sure, but something is lost too.

For example:

• If you are arrested or otherwise get involved with the judicial system, you almost certainly will hire a lawyer (even if you are one yourself);
• If you have or hope to have significant income/assets, you probably have a financial planner and a tax accountant;
• If you buy a house, you usually use a realtor;
• If you have health issues, you are likely to have a physician, and other healthcare professionals.  

The legal, financial services, tax, real estate, and healthcare systems have each evolved to the point that laypeople don't expect -- and aren't expected -- to understand them.  They and other parts of our lives are growing increasingly more complicated, making us ever-more dependent on those experts.

The thing is, this state of affairs is not preordained.  It doesn't have to be this way.  The truth is that this complexity serves the professions that revolve around it.  Lawyers draft the laws, tax professionals design the tax code, and healthcare professionals create the operating structures of our healthcare system.  

A good example of this are the new requirements for hospitals to list "prices."  Instead of promoting transparency, they reveal the convoluted charge structure behind hospital bills.  They use terminology most people don't understand, is at a granular level most won't actually get charged at, and reflects gross charges rather than negotiated prices.  It's like looking at the SKU of every item used in making an automobile and trying to figure out what you'll pay for the car.

Credit: Caitlin Hillyard/KHN illustration; Getty Images

ICD-10, CPT, RBRVS, HCPCS, ICF, NDC, DSM -- these are all examples of systems that are used in healthcare to describe your condition and/or treatment, in an effort to diagnosis and bill.  They are all monstrously complex and growing moreso.  

We can keep making them more complicated.  There are reasons why we do.  That doesn't mean we should.  

Instead, we should be looking for ways we can stop disintermediating people from the things they are trying to do.  We should be helping people be their own experts, rather than relying on more, and more specialized, experts.

For example, it used to be that the "expert" in buying a car was the car salesperson.  You might try to negotiate with him/her, but there was a huge information asymmetry.  The internet has largely leveled that; the car salesperson still has the edge, because he/she does it every day, but it is at a least a fairer negotiation.

Or there are products like TurboTax, which uses software to let you replicate the tax experts.  Input a few numbers and it can produce your returns, even file them.  In financial services you can go online to buy and sell stocks, bonds, and mutual funds, using various tools to help you pick the best ones for your risk profile, all without any intervention of a financial planner.   

Similarly, there are now services that let you skip using a realtor, allowing you to view/list property online and using an attorney to oversee the paperwork -- all at a substantial discount over a realtor's commission.

Then there's healthcare.  Despite the massive amounts of health information available on the internet -- sometimes referred to as Dr. Google -- in receiving healthcare services we are nowhere near even the parity we might feel with a car salesperson in buying a car.  We don't know enough and we understand less.    

Indeed, healthcare is going the other direction, with calls for "social prescribing" or "exercise prescribing" as examples of the healthcare system trying to take its influence further into our daily lives.  It is true that much of our health happens outside the healthcare system, but that doesn't mean they should become part of it.

Instead of being cowed by healthcare professionals' expertise, we should be thinking of this great quote:

Otherwise, it's just healthcaresplaining.

Previously, I wrote that healthcare has to "do simple better."   I still believe that, but it is necessary, not sufficient.  It needs to make more things -- a lot more things -- simple.  

Tom Vanderbilt had a great article in The Atlantic about "reverse innovation" in healthcare.  Reverse innovation is "taking a technology or solution born of the resource constraints in developing countries and adopting it in wealthier ones."  Some call this "popsicle-stick" thinking.  

As he concludes:

But, in a country like the U.S., faced with spiralling health-care costs and access-to-care issues, where innovation typically leads to more expensive and sometimes unnecessary technologies, it may be time for medicine, still often dominated by a closed, guild-like mentality, to think more inventively. Home Depot might not be a bad place to start.

Healthcare could use "reverse innovation" in so many ways, in the broadest sense of the term.  We should be looking to make the healthcare system simpler.  We should be using language that ordinary people understand.  We should make encounters with the healthcare system less scary, and certainly less frustrating.  We should treat us like our health is our business.  We should help make health our business, and us the experts.

This kind of change will come from both purposeful design and the availability of self-service tools like AI, and it is inevitable -- although neither quick nor easy.  

Enough healthcaresplaining: we are not stupid; it is the healthcare system that is stupid.