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.
July 23, 2010
It’s no surprise that a recent study found that patients had gotten lost in the shuffle in medical homes. Patients get lost in the shuffle in virtually all attempted fixes for health care. While medical homes offer many benefits over care that is less coordinated, they still tend to focus on what doctors/nurses/others do rather than on the impact of their actions on the patient and whether they advance the patients’ goals.
See Killer Cure: Why health care is the second leading cause of death in America and how to ensure that it’s not yours. Chapter Thirteen, “The Blind Men and the Elephant,” discusses twelve fixes for health care and why their failure to focus on the patient means that they can’t possibly succeed as planned today.
July 22, 2010
July 21, 2010
“In all the discussions about patient-centered medical homes, one group of individuals has been conspicuously missing: the patients themselves. . . .” As doctors and nurses in pilot studies became very enthusiastic about their work when it was restructured to fit the specifications of a medical home, “patients were unhappy. . . . In working so hard to adopt changes on their patients’ behalf, clinicians had . . . lost their focus on the patients themselves.” From “Putting Patients at the Center of the Medical Home,” by Pauline Chen, New York Times, 15 July 2010.
July 20, 2010
If your doctor’s office uses a team approach to manage your care, ask questions and provide feedback if you are confused about any aspect of your care. Doctors, nurses, and others in doctors’ offices that are organized under “medical home” principles (which include having a team of people to help manage your care) will generally be receptive to addressing your concerns since they spend a lot of time trying to figure out how to get good results for you.