I was thinking about the state of medical care lately and thought this would be an interesting experiment (but not likely doable).
Imagine, if you will, a one month Metabolic Cruise. To replicate real life as much as possible, no food or drink would be free. It would be available as it is in every day life at normal market values in a variety of stores, restaurants and bars on the ship. There is 24/7 video surveillance and each person has a GPS tracking advice. Each person uses a card to purchase what they consume and places unconsumed foods in a receptacle to be analyzed. In other words, a sort of free-living metabolic ward. Of course rooms would need a kitchenette too. But this cruise to nowhere would not allow for foods from outside sources. Legally solid assurances were made from the outset that all video and such would be destroyed following analysis for compliance.
At the end of the cruise, full metabolic workups would be done and the patients would fill out a typical medical history (which could be verified?) survey including self reported lifestyle. They would also get weight, body composition, gender, age. Then all of this would be sent off anonymously for several doctors to evaluate independently. Perhaps there would be so many patients that each doc would "see" the same patient twice -- once provided the self-report, and once provided the cruiseship records -- or two groups of docs would evaluate patients in some sort of randomized fashion so that there was no rhyme or reason as to which doc group evaluated verified/self-report data. Again, a legally superbinding agreement would be in place. The docs would never know the identities of the patients, and the patients would be the only ones to receive any identifiable info. Not even their family doc would get the results unless they directed it.
My reasoning for this post:
I think a lot of us have one or more "unhealthy" habits -- whether or not the establishment thinks they are -- that we are likely to .... erm ... stretch the truth about with our doctors. It is well known in the statistics field that anonymity can drastically change the outcome of surveys -- the more controversial the topic, the more divergent the results.
Those in my age group probably related "big time" to the classic Seinfeld episode about the "permanent record". As kids, if we got in trouble, we were scared sheetless that it would go on our permanent record and follow us throughout our lives. (Ha! Was that a big lie. Nobody ever gave a damn what my extracurricular activities were in college, save, perhaps my first employer, let alone that I led a little mutiny at recess in the 2nd grade convincing half the class to stay out with me in protest over who-knows-what!) With changing healthplans, pre-existing conditions, life-insurance premiums on the line, etc., I think we are becoming more and more loathe to be honest with our physicians about even innocuous behaviors. A diabetes diagnoses is, apparently, permanent as it stands, even if someone reverses it with lifestyle changes. Stuff like this ...
Based on this sort of scenario, I'm curious what you think might happen. Do you think the different docs would come to the same conclusions/recs re: health and corrective measures? Do you think the evaluations would change based just on whether real or reported lifestyle parameters were provided? How about the "bluntness" of the advice. Do you think dishing the cold hard truth out to a nameless/faceless person in an impersonal manner would be easier or more likely to be what needs to be said vs. what a patient wants to hear? How about the patient. Do you think a more objective appraisal of one's lifestyle might impact behavior?
What say you?