By LEE BOWMAN
Scripps Howard News Service
June 01, 2008
A new report out this week from the government's Agency for Healthcare Research and Quality gives some daunting numbers. Six out of every 10 Americans 18 and older has at least one chronic medical condition.
That means in the average office building elevator, most of the people on board have a medical problem that can be expected to last for at least one year and result in physical limitations or the need for ongoing medical care.
The numbers come from a 2005 federal survey of spending for health care services around the country.
To be sure, chronic illness is more prevalent with age. Nine out of 10 people 65 and older have at least one condition. Still, so do 4 in 10 Americans between 18 and 34 years of age.
Among the bigger categories (keeping in mind that some people have more than one): high blood pressure, 45 million; asthma or chronic obstructive lung disease, 45 million; arthritis, 22 million; heart disease, 19 million, and diabetes, 17 million.
Of course, this assumes that everyone's getting the right diagnosis.
A recent special edition of the American Journal of Medicine published a collection of studies looking at diagnostic errors. The reports suggest that doctors miss the call at least 5 percent and often up to 15 percent of the time, depending on the area of specialty.
Other reports suggest, for instance, that up to 30 percent of Americans with diabetes don't know it, in large part because doctors either don't screen for the condition or don't use the full range of available diagnostic tests.
Docs, like anyone else, don't like to admit or acknowledge mistakes. And many still work under systems that don't tell them. Despite decades of more tightly managed care and a variety of efforts to collect patient information and make it available electronically, all too many Americans still don't have a consolidated medical record or a single doctor or even a single practice coordinating their care.
If one doctor doesn't find what's wrong and make us feel better, chances are we'll move on. If we can't get an appointment, we go to the ER or the retail clinic. And chances are, we don't tell the regular doctor, if we have one, about those encounters.
For a variety of reasons, personal and economic, even people who know they have a serious medical problem tend to avoid or delay getting care, skip tests or treatments and are less than disciplined about making diet or lifestyle changes that are in their best interest.
And that pattern is all the more worrisome in light of another recent report, also from the AHRQ, about American adults' ability to manage their own health care.
It turns out that just 12 percent of 228 million adults are "proficient" in their health literacy skills, meaning they're able to find and use health information to make good health care decisions, can calculate health insurance costs and are able to fill out complex medical forms.
Only a little more than half of Americans were found to have "intermediate" skills such as being able to read instructions on a prescription drug label and determine the right time to take it.
About one in six adults are only able to follow short, simple verbal instructions about their health care, the study found.
So, while it sounds great when fans of health savings accounts and "patient responsibility" talk about people managing their own health care and finding the best bargains for treatment, the reality is that darn few Americans have the skills, not to mention the time and determination, to make those decisions.
Yet it's ever harder to find a doctor, or even a nurse, who has time to guide us through the options for what ails us.
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