I’m not really a technology guy. My choices in gizmos reflect this…the intuitive Apple computer, Zoom videoconferencing, athenahealth’s EMR, etc… My view of “meaningful use” is very different than that of the Department of Health and Human Services. While they define “meaningful” with a carrot and a stick, I tend to define in relational terms. To me, the amazing technology at our fingertips is only as valuable as its ability to serve and support our relationship to each other and to our collective wellbeing. And most importantly, to the patients we serve.
Our work at ResolutionCare is built on the energy and strength of a team, realizing that the current structures in our healthcare system no longer serve us. These structures no longer support the wellbeing of these folks we call our “patients”, and they no longer support the sustainability of our own roles as professionals.
I won’t belabor the horrors faced by sick people to extract value out of our dis-integrated healthcare delivery system. I won’t offer yet another diatribe on the exploitation of sick people by “fee-for-service” incentives. And I don’t have to complain to this readership about the unworkable and unsustainable role of healthcare providers as the engine of revenue production and the bottleneck for all bureaucratic processes that serve the multitudes of stakeholders other than sick people. I won’t, and I don’t have to, because this is the fouled air that we breathe every day. The “bad” news and the “good” news are the same…our healthcare system is disintegrating.
When the ground shifts under your feet, it’s best to shift with it or you will fall…hard. Economic incentives are being turned upside down and a seismic change is approaching. Anyone invested in the status quo will founder and sink. What that means is that they and those that count on them-sick people, staff, and most importantly, their families-will suffer as they cling to the past. Though it may be tempting to vent and lament about how great things used to be, (even though it wasn’t that great—trust me; I was there), the dynamism of our society and our capacity for blindingly fast transformation might give a sense of hope rather than defeat.
What we know from our own lives is that our character and sensibilities are forged by adversity and difficulty. As an observer in the care of people facing the completion of their lives, I am convinced that the “pain points” are what awaken the inspiration needed to confront habitual problems, narrow self-interest, and self-destructive tendencies. Our healthcare system belongs to us, and it is our responsibility to recreate it so that it becomes entirely centered on value. And value, in our new healthcare system, must be defined by the experience of the very ill and those of us who wish remain as well as possible throughout life as we interact with our healthcare system.
As a palliative care physician, I have come to realize that in all of human history, people have never suffered as they approach to dying in the way they do today. Despite the absence of technology, advanced medicines, and defined roles for healers we have today, our predecessors had what people have always needed the most…the presence and care of those who loved them. Our ancestors also had a much better understanding of death as a natural part of our experience as human beings.
We need to restore the traditions of compassionate home-based care and the capable and judicious use of a few simple principles of medicine. And we also need to integrate telemedicine technologies as a way to strengthen the relationships we have with our patients, not to industrialize those relationships. If technology is used to better support a trusting and healing relationship and is used to improve the patient’s experience of their care we can actually achieve the “Triple Aim” of healthcare: better outcomes, improved quality of experience, and lower costs.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Even a country doctor like myself can see the writing on the wall. I can engage with our society’s reckoning about our care of very sick people and I can even offer leadership in the creation of the New Normal….from the comfort of my home in a redwood forest.
Say “goodbye” to yesterday and “hello” to tomorrow.
