It is surprising that some vocal commentators simultaneously rail against health care spending and against rationing, without considering a solution that will naturally reduce usage (and hence costs) without rationing anything; ensuring that health care’s focus becomes “to enable people to lead the lives they want.”
July 30, 2010
July 29, 2010
July 28, 2010
“Let me tell you what I really, really want.” Don Berwick talks about learning to skate ski. “It is the closest I have ever felt to flying.” He talks about a beautiful, secluded skate skiing trail in the mountains that leads across a stream and up a hill to a stand of young birch trees. “I don’t know any lovelier spot in the whole world. If you are lucky . . . you can stop there and . . . in the silence, you can watch a busy red squirrel and feel totally at peace.”
He describes a problem in his right knee. “The problem is osteoarthritis, it comes from medical error, from botched surgery when I was a medical student, aggravated by years of jogging. In December 2004, in very bad knee pain, I was scheduled to have a total knee replacement. But at the very last minute, a few days before my surgery, an orthopedist, a third opinion actually, suggested trying a steroid injection in my knee. My surgeon agreed to try, and here I am.”
“It’s five years later, and just one more steroid shot later, and I’m limping a little, I’m almost pain free, and I have my own knee still in place. It’s not a perfect knee. I can’t jog even a single step. I have to wear special orthotics. When I hike I have to use poles to take some weight. But here’s the important point. I can skate ski. I can skate ski all I want. With a metal knee I probably couldn’t, because a metal knee can’t take the torque. . .”
“Next weekend I will be up there quiet [on the trail] leaning on my ski poles and watching a little red squirrel watching me. What health care do I want? Well, of course what I want is safe, effective, evidence-based health care for my knee. What do I really want? I want to skate ski on that knee. What I really, really want is five minutes on a sun-filled blue sky 20-degree February afternoon in total silence leaning on my ski poles in that little stand of birches watching one busy red squirrel. Now, I’m not saying I won’t need a metal knee some day, I probably will, but just not yet, not yet. Health care wanted to give me a metal knee. It was very ready to move, on a dime, and I wanted to visit a squirrel. My care was dignified, it was professional, but it missed the point.”
Don Berwick, plenary speech “Squirrel,” IHI’s 21st National Forum, 08 December 2009.
July 27, 2010
Ask yourself what you really, really want from health care.
“I’m going to bet nobody really wants a doctor visit or a blood test or a CT scan or a night in the hospital . . . You want Thanksgiving dinner with your family. Or quiet time with your partner. . . Or a dive in the cool water. Or to see that Van Gogh or hear that chorale one more time.. . . Health care has no intrinsic value at all. None. None. Health does, joy does, peace does. . . A health care system that gives us each what we really, really want . . . can be a system sustainable for our futures and for our children’s future. It is different from the one we have . . . We just have to ask first, “What do we want?” . . . “When it comes to your health and health care, what do you want? . . . What do you really want? . . . What do you really, really want?” Don Berwick, plenary speech “Squirrel,” IHI’s 21st National Forum, 08 December 2009.
July 26, 2010
Myth or fact: Berwick does not believe in rationing.
Fact: he does not believe in rationing. “I cannot imagine that a civilized, developed country is actually going to deny highly effective and humane care to its people, that we’re going to say to Americans, ‘Too bad, medical science has something that can help you but you just can’t have it.’” Don Berwick, plenary speech “Squirrel,” IHI’s 21st National Forum, 08 December 2009.
He goes on to talk about both giving everyone the care they need and spending less to do it — a solution based on health care whose focus is, in my words, “to enable people to lead the lives they want.”
Newly named to run the federal agency that oversees Medicare and Medicaid, which pay almost half of the country’s health care tab, Berwick has great and practical insight into health care’s problems and how to fix them.
May 28, 2010
|Don Berwick, eminent Harvard-trained physician, has told stories about the high volume of medical errors, medication errors, fragmented care, and other grave problems in health care delivery that have caused grievous harm — in his own family: stories about the care received by his father, by his wife, and by Dr. Berwick himself. No one is exempt; big changes are needed throughout the health care system for health care to enable people to lead the lives they want.|
May 27, 2010
May 26, 2010
|In May, 2009 Berwick wrote an article in the journal Health Affairs titled “What ‘Patient-Centered’ Should Mean: Confessions of an Extremist.” I wrote a response, suggesting that he wasn’t being extreme enough, and that health care needs to adopt a new purpose: to enable people to lead the lives they want. His published reply: “I agree completely with Ms. Bewley. The value of health care lies in the production of health, itself. I recoil when I hear ‘throughput’ as a measure of productivity in health care. What better measure of results could we ask for than the one Ms. Bewley proposes: ‘to enable people to lead the lives they want?’”|
May 25, 2010
|If you routinely feel diminished in dealing with a health care professional, and your polite attempts to correct the situation don’t work, it may be time to look elsewhere for care.