Try not to be patient…

Sorry if this is way off topic or seems out of place…but Jen and I talk quite a bit about patient care and the state of our medical system in the U.S. for many reasons. Here is a writing from the guy just appointed to head Medicare and Medicaid. Maybe he can reverse the slide that patient care has seen over the last (insert time period here). This article hits home from one line you will read if you keep going. Of the time I spent with my father in the hospital, it hit me that maybe people weren’t paying him enough attention or doing things for my dad simply because they all called him “Lawrence”. I do not remember a single person who stopped to ask him what he would like to be called…it certainly wasn’t Lawrence, although he would never say anything. He was just 8/16/1940.

From Dr. Berwick

I freely admit to extremism in my opinion of what patient-centered care ought to mean. I find the extremism in a specific location: my own heart. I fear to become a patient. Partly, that fear comes from what I know about technical hazards and lack of reliability in care. But errors and unreliability are not the main reasons that I fear that inevitable day on which I will become a patient. For, in fighting them, I am aligned with the good hearts and fine skills of my technical caregivers, and I can use my own wit to stand guard against them.

What chills my bones is indignity. It is the loss of influence on what happens to me. It is the image of myself in a hospital gown, homogenized, anonymous, powerless, no longer myself. It is the sound of a young nurse calling me, "Donald," which is a name I never use—it’s "Don," or, for him or her, "Dr. Berwick." It is the voice of the doctor saying, "We think...," instead of, "I think...," and thereby placing that small verbal wedge between himself as a person and myself as a person. It is the clerk who tells my wife to leave my room, or me to leave hers, without asking if we want to be apart. Last month, a close friend called a clinic for her mammogram report and was told, "You have to come here; we don’t give that information out on the telephone." She said, "It’s OK, you can tell me." They said, "No, we can’t do that." Of course, they "can" do that. They choose not to, and their choice trumps hers: period. That’s what scares me: to be made helpless before my time, to be made ignorant when I want to know, to be made to sit when I wish to stand, to be alone when I need to hold my wife’s hand, to eat what I do not wish to eat, to be named what I do not wish to be named, to be told when I wish to be asked, to be awoken when I wish to sleep.

Call it patient-centeredness, but, I suggest, this is the core: it is that property of care that welcomes me to assert my humanity and my individuality. If we be healers, then I suggest that that is not a route to the point; it is the point.

- Dr. Donald Berwick