Sep
05
An experience shared – time to consider a patient-centered approach to healthcare
On average patients visiting their primary care physician will spend 50 minutes in the clinic and only 10 minutes with the physician.
Does this sound familiar? How does that make you feel toward the health system?
What about hospitals where medical staff don’t even introduce themselves to patients. This is the experience of Dr Graham Martin, Professor of child and adolescent psychiatry at the University of Queensland. Dr. Martin shares his story on ABC Radio Australia program – All in the Mind, a favorite source of interesting Mind-Body related interviews. Past programs are downloadable as podcasts and all those I’ve listened I have found to be most fascinating, but this one with Dr. Martin is one worth writing about. It’s not what Dr. Martin does that is of interest, but rather his experience with the medical system.
In 2009 Dr. Martin became paralyzed from the waist down with what was found to be acute transverse myelitis – inflammatory damage to the spinal cord. His experience, from doctor to patient, surprised him and led him to write about this, and his recovery. Dr. Martin’s experience is not one that appears to take into account patient wellbeing and of this he suggests, “hospital bureaucrats should have the privilege of spending a few weeks (as a patient) in their own hospital”.
I’ll leave it to you to read or listen to the interview and also have a look at Dr. Martin’s blog (which makes for wonderful reading, especially his Haiku’s). For this article I want to highlight some of his more pertinent reflections and comments, and some other sources that suggest change toward a more patient centered health system is necessary.
Dr. Martin’s statement emphasizes the need for doctors and medical bureaucrats to understand or at least have an essence of what care in their facility is like for patients.
As a leading medical practitioner in the system, Dr. Martin reflects that his treatment was intolerable. For a duration of seven hours he was not given any food, ‘or even a cup of tea’. He was not acknowledged by the various people examining him and taking tests, nor for that matter did most introduce themselves. Sound familiar?
He shares that it was only when he left his business card on his chart that people started to take notice, but not by much, all he got was a cup of tea.
He didn’t think to ask if the people examining him and taking tests were qualified, even if they did seem completely incompetent at times. “I didn’t ask him whether he was qualified. I mean you don’t, do you, in a kind of passive situation? You’re expecting people to know what they’re doing”, says Dr. Martin. Therapeutic support was also negative and defeatist at best. He recounts one physician upon being asked what he (Dr. Martin) could do to improve his status, replied, “I don’t know, I’m a neurologist I’m not a rehab physician.” No offer or suggestion of treatments or other therapies was even considered.
Does this happen in private practice?
I can’t speak to that but it is frightening that it should happen in the hospital system when, in all likelihood, resources of other supporting therapeutic specialties would be at hand.
Dr. Martin went on to do chiropractic and acupuncture treatments of his own accord even whilst he was still being treated in hospital, and says of the hospital medical professionals responses to this, “well the medical profession didn’t know what to make of it…they would say, well as long as nobody else finds out”.
He shares this reflection of his acupuncture experience in his book, Taking Charge: A Journey of Recovery.
The results were (and remain) fascinating. From the first treatment in hospital, I began to get sensations going down both legs. It felt like warm deep pulses travelling down; like a steamroller driving down inside of my legs. From no sensation to these powerful sensations was just miraculous. Within half an hour, I would be dead to the world in the deepest of sleeps, waking some hours later, slightly uncomfortable from lying in the same position for a long time and with dribble on the pillow. There was a deep sense of comfort or satisfaction, a sort of total body buzz I have only got at other times from meditation. The warm bulldozer waves would have ceased, but what were left were wonderful pins and needles all down through my legs and into my toes. I could not describe the joy and hope those sensations left, when before there had only been deadness.
Shared experiences
These are the experiences of one person who knows it should be better. These are also the experiences people encounter in local, public and even private hospital systems the world over. People have shared with me their own stories and frustrations with our local system from cancer treatment to child birth and much of it is consistent with the context of Dr. Martin’s story. A close friend recently went to hospital for a single treatment to relieve sever pain, which should have been administered when she was taken into the treatment room. Instead she was left for 1 ½ hours in an uncomfortable position (unable to move) causing undue stress on the area of the body that was to be treated. She was now in more pain than when she arrived and wonders if this affected the treatment. Why is it that hospital staff consider schedules more important than patients, after all aren’t they being paid to serve patients, not bureaucrat’s schedules?
Are hospitals broken?
Of course they are not broken. Hospitals do provide an invaluable service as does the medical staff. The point of this article and of sharing Dr. Martin’s story is to emphasis how little consideration is given to the holistic, whole body approach of healthcare and healing in many hospital systems and possibly throughout much of the biomedical system.
People are increasingly turning to alternative and complementary forms of treatment and therapy; therapies that take into account the whole person; the physical, emotional, and spiritual. Even environmental influencers are considered.
Here are some readily available statistics:
- The 2004-05 Australian National Health Survey found 1.3 million adults with a chronic health condition (24%) regularly used Complementary and Alternative Medicine (CAM)
- This UK systematic review found that during the period 2000 to 2011, 41% of nearly 100,000 people who participated used CAM (across all studies)
- Amongst childhood cancer survivors 58% reported using CAM in this study, and even more (65%) in this assessment of the National Health Interview Survey in the US
- In a random sample of hospital across Adelaide it was found that 90% of respondents used CAM
The point being emphasized is that the use of CAM is prevalent in society, this is a reality. The CAM therapies and treatments people choose to use varies across countries, communities, cultures, demographics and access to services, but the fact is that there is a wide use of CAM.
Where do you find an integrated approach?
The integrated and / or functional medicine clinic is a new era of health – wellness clinic that is gradually gathering pace in Hong Kong with some biomedical physicians realizing the need to offer patients a more holistic approach to health and wellness. Patients do seek CAM therefore bringing these therapies in-house allows all physicians and therapists alike to know and understand the patient’s history and therefore offer a more holistic approach to treatment – a patient-centered approach. The Institute for Functional Medicine suggests that by shifting from the “traditional disease-centered focus…to a more patient-centered approach” allows for the whole person to be considered in treatment, taking into account lifestyle and environmental factors that may influence or have an impact on short and long term health and wellness.
How has it worked?
As this article from The Intelligent Optimist highlights, we may be seeing a new breed of physician, one who is is setting up “ideal medical practices that put the individual patient at the heart of health care”.
Dr. Martin also supports the principle of patient focused care and that physicians should develop relationships with ‘human beings’, ie their patients, to work toward solutions that help them, or help them find solutions to help themselves. To achieve this listening to patients is essential. A 10 minute consult won’t is not enough.
In establishing the clinics referred to in Grossman’s article the community was given a voice in what they wanted from a clinic. Some of the responses where as simple as no counters separating people from people and a request to offer alternative therapies, even floor plan suggestions where offered. This may sound a little extreme and possibly only available in a small community, however it is worth noting that these doctors decided that what the community had to say about the healthcare services they wanted was more important and relevant than what bureaucrats, who run big managed healthcare centres, say is needed.
A patient-centered approach involves helping people understand that they need to invest in their own health and wellbeing physically, emotionally and spiritually. Through this approach and encouraging patients to be open to a deeper self-understanding, doctors are helping patients take responsibility for their own health and healing and thereby their own wellness.
