16 minutes that will change how you look at the “soul-crushing reality” of healthcare

~ Carolyn Thomas
Mayo Clinic's Dr. Victor Montori at TEDx Zumbro River
       Mayo Clinic’s Dr. Victor Montori

by Carolyn Thomas  ♥  @HeartSisters

I felt like weeping with joy and hope by the end of this TEDx talk by Mayo Clinic’s visionary physician, Dr. Victor Montori. It’s about healing healthcare with kindness and caring.  This is nothing less than a patient revolution to address what he calls the “soul-crushing reality of a healthcare industry that has corrupted its own mission.”

Please watch this amazing 16-minute presentation and share this with the people you care about if you too believe that a patient revolution like Minimally Disruptive Medicine is both important and possible!

 

NOTE FROM CAROLYN: I wrote much more about healthcare problems (and solutions) in my book “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press, 2017). You can ask for this book at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press (use their code HTWN to save 20% off the list price when you order).

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Q: How would your own care be impacted if Dr. Montori’s vision of healthcare were realized?

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Published by Carolyn Thomas

8 thoughts on “16 minutes that will change how you look at the “soul-crushing reality” of healthcare”

  1. Carolyn,
    Thank you for sharing this. One of the principles the Affordable Care Act was built upon was “Patient Empowerment.” AAMOF Providing patients with the information, skills, and resources necessary to Self Manage Chronic Illness — Patient Empowerment — is one of the main legs holding up the ACA.

    But the transition into these types of systems was supposed to be done (or far into implementation) before the ACA went into effect. Well that process, while it’s been done in a few (comparatively very few) areas of the country and only in a few areas of medicine, has not begun on a level necessary to make the healthcare transition a success. So, without one of its legs needed to hold up the system is collapsing.

    I’ve been doing a lot of research in this area and preparing materials for patients regarding things like communicating with healthcare teams, as well as activities and tracking systems so that patients begin to manage their chronic illnesses and live a longer, healthier life.

    For most patients this is a Brand New Concept — isn’t that sad? But our system of healthcare was built around the concept that the physician is responsible for managing a patient’s healthcare (even the concept of having a PCP is in line with the physician being responsible for managing your health.)

    As for the doctors, most of them have offices full of patients. Most are double booked with appointments – patients who are quite unhappy (and act it) because the office is double booked and so they wait, and wait. Then they have to see patients in the hospitals. They have offices (actual businesses) that have to be managed and, even if the doctor has an excellent office manager — they, themselves must be involved in the process and stay on top of things. The doctor also has to make sure that everything they do and recommend is in line with the ACA (regardless of whether or not a patient is insured through the HCM System). Those are the standards by which insurance companies are determining the medical necessity of various treatments (in each individual patient) and if someone (usually a clerk looking at a checklist who has NO MEDICAL DEGREE and whose only experience treating patients is their own healthcare) decides that the procedure/visit/treatment could have, should have been done differently; the doctor, and whatever facility they may have used in the patient’s care, are not paid. Even if they are paid, physicians receive about a buck-two-eighty regardless of the complexity of the patient’s case and/or treatment.

    So, now, while doing all of that and being paid pennies, physicians are also supposed to be “Building Empowered Patients” who understand the philosophy behind and the necessary information, skills and resources to manage their chronic illness. If it wasn’t such a terribly sad situation, it would be laughable. BUT, unless it happens, and pretty soon, the US Healthcare System will collapse (and I don’t mean financially.)

    So I’ve been working on developing materials for both patients and physicians. You see, I began to understand early (when I developed a sudden onset complex cardiac disorder) that while literally each organ in my body had its own physician and each body system had a treatment team…. In my playbook, actively working on the team treating me–there were 21 MD’s with a high level commitment, knowledge, skills and resources collaborating on my case. But despite my extensive medical team (which also included numerous Nutritionists and therapists from various subspecialties), despite the fact that 21 MD’s were working on my care, there was one person primarily responsible for managing my healthcare–ME.

    Most patients and some physicians don’t get this. Unless and until patients with chronic illness begin to “effectively” manage their chronic illnesses, not only will the healthcare system not begin to improve but the quality of life for patients with chronic illness will continue to deteriorate, doctors will remain buried under the magnitude of the tasks they are being asked to perform, hospitals will be stretched to the max and everyone involved will become progressively more angry.

    In my research over the past year, I came to realize that while initially, setting up such a system (where patients receive adequate information, resources and skills training) will take an investment of time and money, but mostly time, And that is the thing most physicians have the least of; they may have a spare dollar, but rarely a spare minute. Yet when programs of Self Management of Chronic illness are adapted, adopted and implemented the results are staggering. The number of days chronic patients are hospitalized are significantly reduced, the number of days physicians are double and triple booked are greatly reduced, the pressure on the staff in the offices and other medical facilities is greatly reduced and the patient’s quality of life is greatly enhanced.

    If it’s a win-win-win situation, why aren’t we doing it and doing it on a mass scale? The biggest block I’ve seen is Attitude. Physicians have to be willing to give up some control and patients have to be willing to take on control which comes with much responsibility. Even when they know there are supports in place to assist them; many patients hesitate. Not a week goes by in the various digital health support communities I help moderate that a patient has a “symptom” and rather than suggesting some basic steps the patient can take (these are not emergency situations) the advice they are given is (not even “call your doctor and see what they think) “Go to the Emergency Room.” Once they are home, back online and dissatisfied in the “lack of care” they feel they received, rather then “call your doctor,” there are shouts of “Go to a Different Emergency Room until one helps you.”

    Until this changes, until patients and doctors work together, until patients have the necessary information, resouces, skills and confidence in their backup should they need it; nothing will change. The healthcare system cannot hold up under this strain. Someone involved in drafting the ACA recognized this. Too bad they didn’t put together a plan to address it.

    Cathy Aumack-Bandy
    Tampa Bay, Florida

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    1. Thanks for your (long) message on a variety of themes, Cathy. I’m not an American so cannot comment on US healthcare or your ACA program (or whatever will replace it under your new president) except to say that, unlike our universal single-payer healthcare system here in Canada (a system that has an overall high level of satisfaction by Canadian citizens), you have a profit-based healthcare system that, as you say, seems to be controlled by insurance companies.

      But because our two countries have comparable demographics, we also have many comparable health needs eg patients living with one or multiple chronic illnesses (which of course is also the theme of Dr. Montori’s presentation on Minimally Disruptive Medicine). As he stresses, more “information” is simply no longer the answer to encouraging more patient engagement if the system lacks first class resources for all, not just those who can afford it. Going to the ER to get a non-emergency complaint checked out is not a good use of that resource, plus such visits clog up ER waiting rooms needlessly – indicating that the patient does not perceive alternative available resources as useful. That’s what Dr. Montori is talking about!

      Self-management programs are certainly valuable for patient who can actually manage them (we have many free programs in place here) – but the bottom line for many is “I don’t need more info, I need not to feel sick”. Best of luck to you…

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  2. It’s a sad state of affairs when clinicians need to be reminded to listen to their patients and treat them with kindness.
    Thank you, Carolyn.

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  3. It brought me to tears… tears of despair. I’m in the clutches of a doctor who won’t listen to my symptoms, which have worsened since she began “caring” for me, due to medication changes she made.

    According to the text she was trained from, I “should” respond a certain way, so if I’m not it’s not her fault, it’s mine. There is no other doctor of her specialty in my region, so I’m stuck with her. I have treated myself in the past, with some success, but my health needs are too complex for the research I’ve been able to do. My husband is not supportive of my self-treatment.

    I’m slowly dying, thanks to this situation, because my body didn’t read the textbook…

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    1. Oh, Holly. Experiences like yours remind me of precisely WHY we need some kind of wholesale shake-up of the way medicine is practiced. Sometimes I wonder if we have to wait until the current crop of med school students takes over from the kind of docs who blame the patient for not responding to their meds – but that’s far too long to wait for most patients. I wish there were something I could say or do to give you some kind of magical access to physicians like Dr. Montori and others like him who ARE working hard to convince their colleagues of this need.

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