Search for tag: "patients"

The gospel that I am trying to preach is to my colleagues in medicine, understand what's happening, learn the facts, lift up your heads enough to see what's going on around you. Understand the problem and then begin to ask yourselves "What can I do to help?"

When I started out in medicine in 1946 there was no such thing as a health care industry. The term health care industry had never been used. Nobody referred to it as an industry and nobody thought that being a physician was a business. Now we are dealing with the inevitable consequences of a health care system, which changed from a social service to a business. Just as you would predict it ignores more or less those who can't afford to pay. It exploits the opportunities to make money at the expense of the obligation to use resources conservatively in the most effective, medically appropriate way.

It invites all sorts of abuses including fraud and it's clear that it's not working and it can't work because there's a fundamental disconnect between medical care and almost all other economic activities in our society. A patient consulting a physician because they're sick, got injured, worried, or frightened that they may die or become seriously ill is not like an ordinary consumer in an ordinary market and physicians should not be like vendors in an ordinary market. Their objective should not be simply to sell whatever the consumer will buy.

Physicians are in the best position to decide how best to use the resources that we expend on health care. I've outlined what doctors might do if they wanted to. They could form multi-specialty group practices not-for-profit group practices that would be prepared to accept payment on a per capita rather than on a piece work basis, on a per capita basis for comprehensive care. There's no question that that system would work.

The only question is, how do we get it to occur politically in the current political climate? That's a big problem, we're going to have to change the attitude of the public and we're going to have to change the attitude of the legislators. It's issue of survival. We are simply not going to survive with the health care system we have now. It's going to implode. We must do something and doctors could help get it started. At least that's my hope and I think it's not unreasonable.

One of the hopeful aspects of all of this is that pretty soon half of all practicing physicians are going to be women. More and more multi-specialty groups are being formed and women are becoming a very significant part of that movement. I'm expecting that women may save the day.

Pediatrics is generally a very happy specialty. When it's sad it's a very sad specialty. I think pediatricians bond together for that reason. You know, I've heard people say they can't even walk into the children's hospital. It's too hard, it's too depressing. To me it's a wonderful place filled with hope.

Working with children is difficult because devices, medications, vaccines are all tested on adults. You're always going to be relying on adult studies and children are not just small adults.

About 10% of all infants in the first 90 days will have a fever. It's a really vexing problem especially for young infants. Because any fever could represent a very serious infection you have one chance in the emergency room to get it right. Do you admit them or do you send them home? And you want to make the right choice.

The current recommendation is all of those infants have medical care and that the majority of them would be hospitalized. But that's hundreds of thousands of admissions each year. It's incredibly costly, in the billions of dollars.

For the last 15 years or so, all of my time here at the University of Utah, I have focused on the development and implementation of something we call the Evidence Based Care Process Model. Using input from laboratory staff, nursing staff, administrators and parents we built a care process model that we could all say, "This represents the best possible care that we could give in our system".

We started small with one virus and now we have technology where we can diagnose 15 viruses, we can diagnose bacteria in under an hour. It's now routine in hundreds of hospitals around the country including many children's hospitals. And so being able to go to a parent and say, "I know why your baby has a fever," that is such a relief. And that's where the joy of it is and that's where the benefit of it is. You know that kids are better off not just here but in other places because you did the research.

Some of the most innovative things that we're thinking about right now are something referred to as milestones. So in the residency world, we're being able to now identify exactly where people are along a spectrum of skills in six different areas and with the idea and vision that as people meet those skills we can move them along the pathway and again get rid of the rigid timelines that we're currently married to.

For those of us who have been doing medical education for a long time, we know some people learn faster than others, and other people learn slower. The fact that we're facing a deficit of 90,000 physicians coming up here very soon in the next decade, we really need to be thinking about: How can we turn people out more quickly? How can we ensure that we get people in the pipeline, keep them in the pipeline, and then turn them out at the end?

I took care of adolescent leukemia patients for eight years. And that's a really difficult thing to do. I cannot tell you that it was less difficult for me on the last day than it was on the first day.

I was taught that gradually you become less sensitive to the patient situation if you take care of patients in desperate situations. I found that to be totally untrue.

The purpose of healthcare is to make a person as healthy as possible. And if that is perfect health, great. There are times in people's lives when that's no longer possible, but to keep them at their highest functioning level, and as happy as they can be for as long as possible. The goal of health care is not just to do that, but to find out what that means for the patient, and do that.

I see all of these things as an opportunity, and how do we take the situation we're in, and help turn it into something that's really great. When we talk about patient experience for example, the patient has a head injury doesn't think of patient experience in the same way as a mother who has just given birth. You can't have a formula for the whole hospital. Everybody does it differently.

What we do here at nursing is we have the right people, and that's not easy. We have to hire people who've got a passion for what they're doing.

We started out with a top down approach, and of course that doesn't work, and I know that doesn't work. So what we said was you take care of patients everyday, you know what your patients need, and I know that you want to make the best possible care that we can for them. Tell me what the barriers are, and my job is to remove the barriers so that you can provide that kind of care for your patient everyday.

I don't dictate anything. I don't tell people what they have to do. I tell them what the goal is, I try to inspire them that the goal is worthy, and then I ask them to think through what's the best option for their staff, and their patients. Then that's how we get all of our innovation.

Most of the things that we do, I had no idea that that's the way it's going to come out. I'm always thrilled to death to see what they come up with. They come up with some fabulous ideas that I never would have thought of. It's imperative that the patient is at the front of all of our conversations. It's all for the patient.

I think we don't really know what patients want. So this is from the perspective of introducing technology and assuming all our patients are techno savvy, and I think you have to ask the patients what they want and how digitalized they are. A lot of our patients are older and may not adapt as quickly to this technology.

I think we need more data on what patients want, and I think patients need to be brought into the discussion. I think the movement for patient and family centered care is increasing at the same time that this digital stuff is going on, and I think if we bring patients into the conversation, we can do this intelligently and thoughtfully.

The thing about social media is it never really goes away. Medicine is not just about telling people what to do and having them do that. It's also understanding their illness, understanding what contributors there are to it. Being able to network with other people that may have your disease or being able to network with the people that are taking care of the disease or researching about the disease is a very important and very useful tool. I think that can drive innovation in solving new problems and getting new research for it as well.

You have to figure out ways to make it to where you can actually take care of patients, because right now we don't have enough doctors to do it. But in the future, if we can align our care with technology and the needs of the patient, we're going to be able to actually take care of more people.

When you look at equipment, we end up in a situation where we're getting much more information at a cheaper cost and able to make decisions that will actually impact patient care. What this has the opportunity to do is to take us in a different direction, that is to say we have high-tech equipment, we have a better understanding of what an individual patient needs, and we'll be able to design treatment protocols based on that. It's radical thinking, but it's the way we need to go.

What we have to confront in our own nation is: Do we have a national commitment to funding research to improve health?

Well, imagine if we have a population that's not healthy, that doesn't have access to the best care that science underpinned. Imagine that absent science we have no idea what works best for whom, in what context, and why.

So how can we confront those challenges? The power of science brings an evidence base to that that really separates it from unguarded or unfounded opinion. So once we have the power of science, we can think about health in terms of improving the health of an individual patient but also of that patient's family, of the community, and the population, many of whom are vulnerable. And I think once we talk about reframing that for innovation as to improving health through all of those, then some of our other challenges may fall away.