Need for a Minimally Disruptive Medicine toolkit

By Nathan Shippee

MDM needs a toolkit for people who are interested. This is not my idea originally—I’m just a messenger. As a junior researcher fortunate enough to be involved in minimally disruptive medicine (MDM), I’ve been able to collaborate with and learn from great people like Victor Montori, Frances Mair, Carl May… the list goes on.

Yet, for all our efforts, MDM remains a good concept, but one with arguable impact. Our research has shown that treatment burden is a real and measureable thing; that managing chronic conditions is complicated and work-intensive; and that medicine needs to recognize the balance between the demands placed on a patient and his or her capacity to handle those demands (see the MDM blog’s Jan 9th post for a bibliography). However, what have these realizations done for patients?

At Mayo (at least while I was there), there was mixed success (Victor mentioned this here). In trying to merge MDM into primary care, for instance, MDM-interested people were able to help some patients in simplifying medications, lab tests and diet, but also encountered barriers, such as problems in changing all the forms patients are asked to complete (especially when they visit multiple specialties at the clinic) or the way visits are scheduled to consolidate them and improve convenience.

We’ve been contacted by providers at other clinics who have read some of this work. Some have had interest in tools to measure the complications in patients’ lives; others have been interested in provoking culture change by educating their colleagues about the difficulties and challenges that patients face.

People at the core of MDM have discovered that it may be impossible to change how medicine is delivered at a given clinic or practice due to institutional inertia, difficulty in getting professionals to buy in, and so on.

Instead, there is a different idea: to provide a toolkit for people interested in MDM and its implementation, built upon existing evidence and collected findings, suggested scales  and new measures, and more, in order to promote a broader impact for MDM on common practice and pm patients’ lives.

Therefore, here is a teaser for what might become a dominant theme in MDM: it is time to create an MDM toolkit—a clearinghouse, go-to place, or whatever one might call this single source for tools that help make MDM to be useable and to have an impact.

Initially, such tools might include:

  • background and literature developments supporting MDM, including bibliographies of recent papers (like the one on the MDM blog);
  • ways to build knowledge and motivate and culture change, such as presentation slides, conceptual model outlines, graphs, and other material to promote MDM concisely and directly;
  • shared decision making tools to improve the involvement of patients’ informed preferences in medical decisions; and
  • survey items or measurement approaches people can use to assess and track healthcare-related overburden and workload-capacity imbalances among patients. Later, based on widespread testing of these tools and focused intervention studies, we might add validated screening tools, field-tested and evidence-based components for building MDM interventions, and updates to our conceptual models and statistics about the solutions to patient overburden, healthcare-related disruption, and lack of support for patients.

This toolkit may sound ambitious, but it is reachable. Developing individual tools that can be picked up for free, piecemeal, and used in practices may be the most far-reaching, and yet also most feasible, approach to ensuring that the promise of MDM reaches its intended beneficiaries—patients.

We welcome your thoughts. What would you add or take out of the toolkit?

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8 thoughts on “Need for a Minimally Disruptive Medicine toolkit

  1. Hi Nathan

    I am a colleague of Frances Mair here in Glasgow. I have also worked with Carl and have met Victor.

    This sounds a great idea and I would be interested in hearing more. I enjoyed your recent paper on complexity. I am currently developing work on prevention burden – building on treatment burden and MDM. would be good to talk.

    Regards

    Kate

  2. Thanks for this, Nathan.

    “Our research has shown that treatment burden is a real and measureable thing.” Every heart patient I know who is living with ongoing cardiac issues already knows this. It’s the medical profession we need to convince.

    I think this MDM toolkit just might be a step in the right direction. I’m dismayed on a daily basis hearing the increasingly loud protests from prominent physicians about their own ‘burdens’ – like being expected to accept things like shared decision-making (for example, read Wes Fisher’s withering attack on this in response to a NEJM perspective piece: http://drwes.blogspot.ca/2013/01/the-costs-of-not-so-shared-decision.html And the Center for Advancing Health tells us that 91% of hospital patients are sent home with NO discharge plan: http://myheartsisters.org/2012/11/11/study-91-discharged-without-written-care-plan/

    It’s the big barriers like those erected by the Dr. Fishers of the world that I’m concerned about in the future adoption of the very wise concepts of MDM.

    • Nate here. I agree; we certainly don’t need to convince patients of the mere facts of those things. As I mentioned, the toolkit is as much about knowledge and culture change as anything else, and I do think an that such tools and a burgeoning evidence base (in the absence of a full-on, patient-led revolution) may be useful in addressing resistance in a measured and effective way.

  3. Thanks for this Nathan – really interested to see how the toolkit develops. We are a team of self management researchers at Glasgow Caledonian University, working on stroke and patient activation – would be great to be able to measure treatment burden as well as activation in developing tailored interventions.

    Lisa

    • Hi Lisa, I am a PhD student at the University of Glasgow, studying the patient experience of treatment burden in stroke. I am fortunate to be part of this MDM programme with Nathan and his prestigious colleauges! Just thought I would leave you a message as our research interests seem similar and we both work in Glasgow. Thanks, Katie Gallacher.

      • Hi Katie,

        Thanks for your message. I’ve come across some of your work recently so I’d love to meet up sometime and hear more about it and share our interests etc, especially since we’re pretty much neighbours!

        bw,
        Lisa

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