Minimally disruptive medicine – the change must come from doctors

By Kate Gilbert (www.d1.org.au)

Minimally disruptive medicine acknowledges the lies that quickly become part of the doctor-patient relationship.  As long as the relationship is about a doctor doling out treatment to a patient assumed to be a willing and able recipient, we are going to have a problem.  ‘Non-adherence’ by the patient is one way to characterise the problem.   Misguided folly by the health professional is another.

When I heard Victor Montori introduce Minimally Disruptive Medicine to an Australian audience last year (video available here: http://www.evertechnology.com/NMS2010/P4a/fHI.htm) I felt like I was listening to one of the most effective patient advocates I’d ever heard.   And he’s not a patient, but a doctor!  I couldn’t wait to share this new concept with other people with diabetes, and the enthusiasm spread quickly, spawning discussions about doctors’ incapacity to relate to patients, the stress and guilt caused by over-burdensome treatment regimes and more (see http://www.realitycheck.org.au/RCforum/viewtopic.php?f=1&t=8662).

I was reminded of Daniel Pink’s Four-Word MBA: Talk less. Listen more. (http://www.danpink.com/archives/2010/10/the-four-word-mba). This is strongly evident in developing the concept of MDM, and the same principle lies at the core of this new approach to medicine.

Victor isn’t the first person to acknowledge there’s a problem.    Patient-centred care has been trying to get traction for ages.   In my part of the world, ‘self-management support’ has received reasonable interest.   But whilst I have followed this with interest, hoping it may reorientate the clinician-patient dynamic, it has had limited impact, and the medical profession has not embraced it.  Perhaps an unfortunate side-effect of its name, self-management support is too often orientated towards the professional and his/her role so that even though it calls for change in that role, like most changes in health, few people implement it completely and we are too often left with people holding a strengthened view of their powers as a health professional to bring about transformation in their clients and limited real change in the relationship.   Meanwhile, I pack out auditoriums whenever we put the topic of ‘Diabetes Burnout’ on the agenda – people with diabetes know the problem all too well and jump at the opportunity to hear and share in that discussion.  Minimally Disruptive Medicine (MDM), in name and in practice, is very clearly oriented to the impact of care on the patient, and a promising place to start bring about critical change.

Montori’s early presentations on MDM have focused strongly on the rationale for a new approach, and only more recently is the next chapter emerging about what this new world might actually look like.  The rationale he presents is irrefutable, clear and compelling.  There wasn’t the zeal of a new fad (which always scares me off, I have seen a lot of fads come and go) but rather it has the passion of a new discovery that has to be shared.   I am looking forward very much to Victor bringing this same clarity and passion to the solution: developing and spreading MDM as a new approach to medicine.  Whilst I am delighted that Victor and colleagues are actively listening (there’s that word again) to patients and patient groups about our needs and views on MDM, and we can strongly support the rationale and be demanding of the change, the actual approach must come from within the doctors whose world will be changed.

Minimally Disruptive Medicine is an important truth, beautifully and intelligently executed.