Atul Gawande, writing for the New Yorker:
They bantered. She was doing fine. School was going well. Warwick pulled out her latest lung-function measurements. There’d been a slight dip, as there was with Alyssa. Three months earlier, Janelle had been at a hundred and nine per cent (she was actually doing better than normal); now she was at around ninety per cent. Ninety per cent was still pretty good, and some ups and downs in the numbers are to be expected. But this was not the way Warwick saw the results.
He knitted his eyebrows. “Why did they go down?” he asked.
Janelle shrugged.
Any cough lately? No. Colds? No. Fevers? No. Was she sure she’d been taking her treatments regularly? Yes, of course. Every day? Yes. Did she ever miss treatments? Sure. Everyone does once in a while. How often is once in a while?
Then, slowly, Warwick got a different story out of her: in the past few months, it turned out, she’d barely been taking her treatments at all.
I’m fascinated by the idea that a major difference between medical centers is not just the quality of the care provided, but the quality of the patients, and how effectively the doctors can evaluate and manipulate the patients’ desire for care.
Probably more of an issue for chronic ailments, but interesting nonetheless!