Of all the things I heard at the Transform symposium at the Mayo Clinic last week, there was just one notion that pierced the heart of all this healthcare reform talk, if you ask me. It was the statement by Christi Dining Zuber, Innovation Director at Kaiser Permanente, that healthcare needs to be about compassion rather than “compliance.”
The traditional notion of a doctor’s role was: “you tell people to do stuff, you push them to do it, and then you track it.” Funny that when large numbers of people failed to perform the “stuff,” no one seems to have thought about critiquing the methods. Rather, experts just assumed that patients were too lazy or stubborn to follow orders.
But t
hank the Lord that seems to be changing for real, finally.
“Health care is humans giving care to other human beings,” Zuber said. “It has to be about compassion, an appeal to the heart.”
I wonder how many of us have had a compassionate encounter with a healthcare provider? Far more common are the horror stories of patronization and blame. Even I could tell you a dozen or more stories of being belittled by a doctor or nurse, and I’m a pretty pushy lady.
The reason I’m encouraged is that Zuber wasn’t the only one bashing the “compliance” terminology. I’ve been to numerous health conferences in the past months, and one after another, experts — including MDs, health plan executives, and health policymakers — take the stage and talk about “motivating behavior change” and “working with patients as partners.” Just buzzwords? Hopefully not. At least talking about it is a good start.
That brings me to two things about the power of talking:
First: The night before my presentation, I went to dinner with a small group of attendees. Somehow we got on the subject of my diagnosis, and I ended up recounting all the gory details of near-starvation weight, blurry vision, dehydration, IVs, insulin overdoses, etc., etc. I could see that these folks were visibly shaken. Wow! what a story… you poor thing! But soon they snapped back into “professional mode,” lamenting that patients don’t follow this or that regime properly. And all I could think was: Do you think I’m the only one with a story like that?! Every patient has been through his or her own little corner of hell. Why can’t you connect those life experiences with our “openness” or ability to perform some pretty unpleasant health tasks day in and day out, for the rest of our lives?
Second: The conference wrap-up was delivered by a brilliant woman named Maggie Breslin, Senior Designer at Mayo’s SPARC research group. After years of studying every imaginable sort of patient interaction in this million-square-foot clinic, what do you think her conclusion is about what good healthcare looks like?
The answer: A satisfying conversation!
“Conversation is how people determine quality and value,” she says. “People love the Mayo Clinic not because of all their state-of-the-art treatments and procedures, but because doctors take the time to talk and answer all patients’ questions.”
Her other conclusions, which seem so intuitive for us patients desperate for a good talk:
- Conversation has therapeutic value. Providers help patients just by talking with them.
- Conversation allows us to deal with ambiguity. It clears up all that confusing science and medical jargon, so we can understand our health issues.
- Conversation is not just a “nice to have”; it’s the essential element of healthcare. Without it, you have nothing.
I couldn’t agree more. So who out there is actually getting Compassion and Conversation from their doctor or CDE when they need it most?
Thanks, Amy! I loved watching the tweets go by from the Mayo conference, but it’s posts like this that really give meaning to the event for those of us who couldn’t attend.
Maggie Breslin’s insight about conversation resonates with something Deborah Peel of Patient Privacy Rights said on Friday at the Health Information Technology Policy meeting here in DC:
“The health care system isn’t even a system; it is a fuzzy, incomplete picture or approximation derived from data amassed from billions of two-person encounters.”
She went on to make a case for an extreme position on patient control over data which Deven McGraw of CDT.org argued would be more hurtful than helpful to consumer rights and privacy concerns. However, I liked how Dr. Peel set out her mission: enable the doctor-patient conversation.
[...] Go here to see the original:Â Compliance vs. Compassion [...]
When Doctors, CDE’s, Nurse Practioners, & Nurses talk TO and WITH the patient instead of AT,it makes a world difference.
Kelly K
It makes a huge difference when a caregiver is empathetic versus sympathetic. While a doctor cannot step into every patients’ shoes and know exactly how they live day in and day out, they need to understand that we all live. And diabetes isn’t 100% of our day. It’s all part of the juggling act that includes family, career, life, and even school. We tell our caregivers all the time “give us some real world help, not textbook help.” When you have a person who truly cares and can give you meaningful applicable advice, it makes all the difference in the world.
Makes me think back to when I had appointments with my first doctor of internal medicine in the 70′s.
He always made time to discuss what seemed to be EVERYTHING, not just my diabetes. We talked about work, college, family life, what gave me stress, what made things easier, etc. He would take a picture of me and used it as part of his analysis of my condition along w/my logs, BP, heart rate, weight, etc.
Of course, then we had poor tools to manage the disease, now we have better tools but less time to sit down and talk about the BIGGER picture.
Fair Winds,
Mike
I am (getting Compassion and Conversation from their doctor or CDE when they need it most) and I consider myself lucky. It’s mostly my PCP. I’ve only seen my new CDE twice.
But, we live in a small town. I see my PCP in other places (and have never asked her a medical question out of her office).
(hee, hee – my captcha is “podding man.” Since it’s your site you’d think it would be woman?!)
Thanks Amy for another post on the conference. Some in the medical community are beginning to realize that it takes two – the doctor and patient to generate success in the treatment for anything, but it seems like some problems like diabetes – that this becomes more important than ever.
It is surprising what can be accomplished when the PCP takes time to really talk with the patient and not at them. However, lets not forget the patient. Too many patients are looking for too little from their doctor and want the quick fix and be out of the doctors office. A doctor can not effectively treat a silent patient. A patient does not need to know everything about patients rights or empowerment, but being silent will not allow the doctor to preform their services effectively.
Thank you for your insights.
Bob
The level of compassion that I have with my current Endo is at a level that I never had with a doctor of any form. The main reason why? She is a type 1 on the same exact insulin pump as me. I feel blessed that I am able to have an Endo that actually lives with the same ups and downs as I do. I think compassion is key and not just tell a patient what to do because you went to college for 6 more years then I did.
As one of my instructors says, doctors should say patients are “adherent/non-adherent to therapy” instead of “complaint/noncomplaint.”
I have not yet run across a type 1 endo for myself, but I would trust a doctor who has been a type 1 diabetic for a year more than a non-diabetic endocrinologist with forty years of practice under her belt. Some things can’t be understood from the outside, and being sick is one of them. Many can show compassion, but few can understand.
Great article highlighting an important point. Talking to patients in a dogmatic, pedantic, condescending manner is not an effective behavior change strategy. Physicians have traditionally seen themselves as a parent figure treating patients like errant children.
As a psychologist I see this in my own diabetic challenges. In moving to the Seattle area I’m with my third physician and have finally found an endocronologist who treats me like an adult with diabetes rather than a disease attached to a recalcitrant non compliant human being. The first two nit picked when I had a hamburger scolding me about diet and not focusing that my A1c has been 6.1 or less for over 5 years.
Until doctors see adult patients as adults and interact as such we will be treated as disobedient children. My advice…..don’t put up with it keep changing doctors until you find one that treats you well medically and humanly.
I have a great doctor. He will discuss anything I feel the need to discuss. If he doesn’t have an answer off the top of his head he will leave the room and go research the question. So far I have never left his office without an answer to any question I have posed. He does not have diabetes but he certainly seems to realize the strain it can pose on a person. Some of his answers have been a little far reaching but so far they have worked well for me. He is entirely cognizant of the difficulties my lifestyle poses in addition to the diabetes and he works with me to overcome the particular difficulties they pose.
I like the idea of the conversation. It makes sense, and hopefully brings both people closer to the same level.
As a psychologist I see this in my own diabetic challenges. In moving to the Seattle area I’m with my third physician and have finally found an endocronologist who treats me like an adult with diabetes rather than a disease attached to a recalcitrant non compliant human being. The first two nit picked when I had a hamburger scolding me about diet and not focusing that my A1c has been 6.1 or less for over 5 years.
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