The Doctor as Patient

Charlotte Yeh is the Chief Medical Officer of AARP Services, and has had a long career in government and as a practicing emergency physician. (Our paths first crossed years ago when we were both working on pre-hospital care reform in Massachusetts.) She wrote a piece published in the current issue of Health Affairs about her experience as a patient after being hit by a car while crossing the street in Washington, DC. Read it. After detailing her frustration with the clinicians in the acute setting more focused on protocols and diagnostic testing than on the patient before them, and her satisfaction with the clinicians in the rehabilitation setting who asked her to define her own goals, she concludes:

If I resolved anything on my care journey, it is that the “North Star” guiding all care must be providers using “any means possible,” to know the patient, hear the patient, and respond to what matters to the patient. It should make no difference where you practice; any provider can do this. Emergency departments can’t hide behind the excuses of “we’re too busy” or “it’s too chaotic” to avoid connecting with every patient.

It is time to frame a new paradigm of care, a consumer-driven approach that concentrates attention on the art of medicine. This might begin with a reinvigorated focus on patient-centered care and mastering the skills of listening, empathy, and patient partnership.

Strong words from a clinical leader, published in in a journal that is a key forum for health policy discussion. Here’s hoping that she is able to engage others in this conversation in a meaningful way.

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7 Responses to “The Doctor as Patient”

  1. B. Lewis says:

    As a nurse, I know this model as “client centered care”, and it’s a fantastic model. I really mean it. Really, genuinely listening, preferably in a private space, sitting and employing verbal & non-verbal active listening techniques provides a vehicle to extend to the client (or patient) authentic concern and a desire to give your very best to help with any health concerns, in a professional context.

    Now, having said this in complete sincerity, there is something more I must add. If the clinic’s hospital administration does not provide

  2. B. Lewis says:

    [… continued]

    Now, having said this in complete sincerity, there is something
    more I must add. If the clinic’s hospital administration does not totally provide conditions for quality care on this level, the most willing clinicians are left floundering and frustrated. By conditions I am talking about several crucial circumstances.

    All staff must agree and understand, from there point of hire, to provide high quality, patient centered care, and implement the model with a high degree of commitment. Otherwise some will do the least possible, while boasting of their efficiency.

    The patient service ratio, and the expectations for practitioners to fulfill other expectations, which are not part of direct care, can not be unrealistic in proportion to time required for care delivery, according to the model. If this rule of thumb is ignored by hospital managers, at any level, the default kicks in like them law of gravity. The default is a brisk efficiency model.

    Patients, managers and others can call this explanation “a poor excuse” for poor care, but that’s just not true, and it’s an insult to staff who want to provide the required amount of time to listen and respond well to needs presented at their assessment phase.

    My last point is this… They very best staff, who repeatedly find themselves in a position where they can not provide good care, will become disillusioned and tired, and they will leave, quite possibly due to health reasons.

    Please allow me to conclude by voicing full support and agreement with excellent assessment and care expectations. However, I must add that without the right conditions for success, the responsibility for lack of success does not lie with the care provider anymore than the egg of a beautiful bird can be blamed for not hatching if the egg does not have the warmth and protection necessary for hatching to occur.

    Agencies that give lip service to a client centred care model, without providing time and support for expected outcomes are no better than any other hypocritical institution.

    • David Harlow says:

      Thank you for your comment. No doubt institutional commitment is a prerequisite to successful implementation of a patient-centered initiative. As the payment incentives that apply at the institutional level are better communicated throughout the organization, one would hope that the behaviors that should follow will, in fact, follow.

  3. B. Lewis says:

    PS The above text was written too quickly, using an auto correct system that is unfamiliar with the word ‘the’. I apologize for their grammatical errors that resulted.

  4. David, thank you so much – I think this warrants center-column treatment here, not in the “stories found on the net” sidebar, so I’m going to change the setting.

    Because of your post, googling found her original story in the Washington Post. It gives me the chills just reading it, and it’s SO valuable to have her common-sense concerns (which many patients feel) expressed by a professional, as you say, e.g.:

    I told the doctor that I had severe pain in my knee and backside. She ordered a CT scan of my abdomen and pelvis as well as a chest X-Ray. Wasn’t she going to examine my knee and backside?”

    Thanks again. I imagine this will be cited a lot, and I hope it gets SOME people (at least) to change.

  5. I mean, this is appalling – from the Health Affairs article, 15 hours later, having spent the entire night in the E.R. hall:

    … they decided I was ready for discharge. “Nothing is broken; you can go home now,” said one of the team members.

    I was stunned. I was still in excruciating vice-like pressure pain, and my knee and backside still hadn’t been checked. The “good patient” in me wanted to please the doctor and saunter out of the room, but the real person in me was scared. I told the team that I wasn’t able to walk after the accident and wasn’t sure I could walk now. I was traveling on business and staying alone in a hotel room, so I might not be able to care for myself, I said. Again, they told me: “Nothing is broken, so you can walk.”

    By now, no one had examined my swollen right knee or left hip area to determine the extent of my injuries beyond broken bones. I knew that serious ligament or cartilage injuries can be sustained without broken bones. No one had talked with me about whether I would be able to function safely at home, or about follow-up care, either.

    All these docs buzzing back and forth, none of them seeing how she was doing. They sent PT to get her to stand up; she crumpled to the floor. Then:

    The resident returned. “There’s no medical reason to admit you,” he said, “but if you can’t walk, we’ll just have to.”

    Seriously? I don’t get mad much, but this makes me want to know names: the hospital, the docs, the supervisors, whoever’s in charge of CARE at this place.

  6. And I’ll say a double-thumbs-up “Hell yes” to Yeh for her next-to-last paragraph:

    It is time to frame a new paradigm of care, a consumer-driven approach that concentrates attention on the art of medicine. This might begin with a reinvigorated focus on patient-centered care and mastering the skills of listening, empathy, and patient partnership.

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