It really hit home for me this past week as to why we do what we do here at Integrated Loyalty Systems.
Dr. Atul Gawande, a practicing surgeon at Brigham and Women’s Hospital in Boston and professor of health policy and management at Harvard Medical School, spoke in Orlando, and I was thrilled to have had the opportunity to see and hear him.
He is a staff writer for the New Yorker Magazine and the author of four New York Times bestsellers and he’s on a singular mission to change how we think about mortality, death, and dying.
Dr. Gawande’s speech really gave me pause to consider what matters most not only to patients of the clients we serve, but also to my own family.
To Fight Or To Quit?
He began by stating that he (and most doctors, for that matter) didn’t learn about mortality in medical school. His point was that in medicine, the general consensus is that the caregiver’s job is to diagnose and fix a person’s body so that they can get back to living a healthier and more independent life.
Sometimes the “fix” (medical treatments required) is a temporary departure from a healthy, independent life, but we choose to sacrifice today for a better life tomorrow.
However, this mentality becomes an issue when our aging, frailty, and mortality come into play.
As we approach the end of our lives, the important question really should be, “Do you want to fight, and if so, what do you want to fight for?”, instead of the typical question we ask, which is, “Do you want to fight or quit?”
Of course,no one wants to quit. But quitting isn’t necessarily the opposite of fighting.
Identify the Patient’s “Minimum Quality of Life”
A follow-up question to ask the patient is, “What is the minimum quality of life you want?”
In Dr. Gawande’s examples, he said one dying patient answered that question by saying, “I want to eat chocolate ice cream and watch football on TV.” So, when treatment options were offered, if they didn’t meet this man’s minimum quality of life standard, then the treatment was declined. He wasn’t quitting. He was meeting his quality of life standard. And he was making this day the best possible day now. He wasn’t sacrificing today with a painful treatment in hopes for a better day tomorrow.
Dr. Gawande’s father’s minimum quality of life standard was to keep doing surgery. One woman’s answer to the question was to keep teaching piano lessons in her home. Gawande’s point is that suffering occurs when your treatment is out of line with your personal priorities.
This part really spoke to me.
At ILS, our core philosophy is rooted in humanizing the patient experience. We do this by elevating the human (or the service excellence) side of healthcare.
We do it when we ask the patient’s preferred name and then use it, rather than just reading the legal name off the chart.
We do it by sitting with the patient, or holding a hand, making eye contact, and listening with the intent to understand, rather than rushing right to the business at hand (diagnosing, prescribing, treating, etc.)
We do it when we remain silent after we deliver bad health news, so as to give the patient (and their family) a moment to process the news.
We do this by considering things from the patient’s point of view — not just with the goal of being patient-centered; but with the goal of becoming patient-driven.
What is most important to them has to become what’s most important to us.
Clinical outcomes and safety protocols aren’t compromised; instead, human kindness becomes hardwired into the clinical processes so that patients feel valued and are engaged in their own care, treatment, and healing.
A Radical Shift In Thinking: Well-Being Is Bigger Than Safety
A complementary point he made was that we shouldn’t lose sight of the fact that well-being is bigger than safety. Consider a woman in a nursing home whose life is entirely controlled by external factors. If it makes her happy to eat cookies, rather than pureed food, then let her eat cookies!
One radical nursing home replaced the nurses stations that are in the center with a kitchen and a well-stocked refrigerator that anyone could eat anything they wanted from. It’s a shift in thinking.
It was a very moving speech filled with real stories of real people, and I attempted (probably in vain) to conceal my sobs and runny nose from the people around me so as not to embarrass myself too much. I must admit, it did make me feel better when I heard someone two rows behind me do one of those gulp-sobs.
This is such an important shift in our thinking that we need to address. At ILS, we help organizations improve their patient experiences. And, end of life care is a big part of many patient experiences because that is when the majority of us need the most care. It’s an opportunity where caregivers can have the greatest impact. And, it’s where most of the healthcare dollars are spent.
Our tagline is “we provide solutions for elevating the human side of healthcare.” Dr. Atul Gawande’s thought leadership to change our thinking about how we approach this is right on track for all of us who work in or with medicine to elevate the human side during end of life care.
It’s not just about fixing the body. It’s about healing the body, mind, and spirit.