Oct 28, 2010
Are inefficient structures and behavioral patterns among doctors, patients themselves, or within the healthcare system as a whole responsible for this situation? Annette Reuter, a doctoral student at Freie Universität Berlin, is using diabetes treatment as a case study to examine the background behind medical routines from a social science perspective.
Unlike type 1 diabetes, type 2 diabetes is not hereditary. Instead, it arises due to lack of exercise and an imbalanced diet. Patients often suffer from the long-term consequences of the disease, which are very costly, as Reuter has found in her doctoral project.
Reuter, a sociologist, is completing a doctoral program at the Pfadkolleg Research Center, which operates within the Department of Business Administration at Freie Universität Berlin. The unit examines the efficiency and inefficiency of “paths,” or behavioral patterns. “When I looked at the processes and structures used in our healthcare system, I found a whole host of examples of path dependency, meaning processes that have become too entrenched,” Reuter explains.
The current practices surrounding diabetes treatment and care, she maintains, are responsible for creating inefficient situations among patients. Reuter, who worked as a registered nurse herself before going back to the university, is studying what happens between the patient and his or her doctor in the course of everyday treatment. To this end, she analyzed a long-term study that assessed information on diabetes patients who saw physicians in private practice from 1989 through 2009. What Reuter wants to find out is whether physicians tend to prescribe medications right away after the initial diagnosis instead of giving patients a chance to treat the disease by changing their diet and exercising more. Conditions in the healthcare system and the industry itself, Reuter says, promote the routine premature administration of medication.
As one potential way out of this “dead end,” she suggests that diabetes care should be organized, more often than up to now, according to a team concept that includes physicians, patients, health workers and caretakers, and family members. This kind of approach is already in place at some medical practices. Reuter also says that professional standards of care should be emphasized more strongly, something that has not been possible thus far in our current system. The reason is that the existing training framework, which is set by the regulatory authorities, is restrictive. For instance, it permits health workers and caretakers to make their own decisions only under strict limits.
The aim of Reuter’s suggestions is to urge physicians to return to “trying out new things more and also appealing to patients’ own initiative,” the researcher explains. More incentive could be created, for instance, for approaches that delay the occurrence of the long-term consequences of type 2 diabetes even without medication.
The interdisciplinary Pfadkolleg Research Center, a research training group funded by the German Research Foundation (DFG), was founded in 2005. In 2007, it became the first social science program to be affiliated with the Dahlem Research School at Freie Universität.