Two Views of World-Class Patient Care — Inside-Out and Outside-In
Can We Create a World in which Kindness is Infused into Patient-Centered Medical Care?
During the past few days, my wife and I have tag-teamed as caregivers for our hospitalized young adult, now 30 years old.
If you happen to be sick, our fragmented health system is complex and difficult to navigate. In-patient care is characterized by dozens of interlocking gears; for patients with rare and often hard-to-diagnose diseases (as well as their parents and caregivers), those gears frequently grind. Hospitalization is a tiresome, problematic, exhausting journey for many.
Learn to Sink or Swim
As patients and caregivers, you learn to swim or sink. While life goes on outside the clinic or hospital, life is often at a frightening standstill for the patient. Concerned caregivers must remain vigilant and their frequent requests and questions about care usually appear to bother care providers who are trying to stick to scheduled rounds or meet emerging floor-visit demands. The entire experience of being hospitalized can drain the patient’s emotional energy, especially those like our child, who has chronic health episodes that pop uninvited into their calendar.
It’s exhausting to be hospitalized or have a loved one in the hospital. Each shift change begins the journey of explaining things anew. You have to stay on top of medications. There is a constant parade of “attendings” who filter in and out: occupational therapists, physical therapists, and specialists. There are the swing-by visits by people checking vitals. Many questions are asked, but answers or possible remedies are offered less frequently. The gears grind on as your journey continues in difficulty.
That’s the frustrating reality we face as patients and caregivers, but something brighter happened during this visit: something different. Some hospitals, like the one we’re now in, seem to “get it.”
We are Always People — Just Sometimes Patients
While we don’t usually want to be in a hospital, we DO want to be treated like valued customers, not pieces of organic equipment shunted among house staff as part of the business of care. Two essential pieces of the system — provider and patient — have a relationship that too often feels like the sterile relationship between Mars and Venus. The patient-provider experience should be more harmonious.
NYU Langone has gone out of its way to be helpful and empathic. Without exception — from the front desk, where we renew our daily visitor badges, to food service, to the 17th-floor nursing and allied health team stations, to the attending physicians and residents who make their visits — each member of the hospital care team impressed. They hear our concerns and questions about “what’s next” and demonstrate active, sensitive listening skills. They are creating a world in which kindness is infused into patient-centered medical care. Patient satisfaction metrics matter here, and the system is built to accommodate them. NYU Langone “gets it” and walks the walk.
We have diagnosed the illness that plagues our health system: a virus called fragmentation. It’s time to examine our biases, behaviors, and business goals. A hospital’s primary mission should be to recognize that we are always people — and only sometimes patients — and that we are seeking to enjoy a healthier life.
We view fragmentation as a wall preventing us from accessing better care. In that case, health professionals in every ecosystem sector can be empowered to pursue their calling passionately with an eye toward tearing down that wall. Our experience during this chapter of our lives has shown us that it is not only possible, it has been achieved.
Looking for a villain in the health ecosystem, something Washington lawmakers have been doing for the last several election cycles, may be suitable for campaigning. However, it is not suitable for progress, continued innovation, or patient care. Progress can only be achieved when we get past the mindset of the time we have been—the period of acknowledging the system is fragmented—and begin to view the system through the lens of health kinetics and eco-dynamics.
Part of the journey to healing both people and the health system may lie in investing in the people on the frontlines of care delivery and creating an environment in which we treat patients as real people who happen to be in difficulty and under duress.
Infusing Empathy into Care
This visit feels as though it brought me closer to answers. It has undoubtedly addressed one lingering question: “Is it possible for medicine to begin to organize around people (the patient and their caregivers) rather than making the ‘system’ the priority customer?”
I am encouraged by this visit. Unfortunately, there will likely be other trips to this hospital. I am eager to see if the superpower of the 17th-floor health team extends to all corridors. When science and empathy converge, the passion of healers to help and the desire of those seeking healing find common ground. It has to begin sometime and somewhere — perhaps by placing the patient at the center of the health value system.
