Beautiful Healthcare
If you close your eyes and imagine the best kind of healthcare, what do you see? If everything were working as well as it could, what would that look like?
Young people are likely imagining healthcare anywhere, anytime and ontime. You could sprain your ankle on a mountaintop, and your doctor four states away could provide advice. While working at your office downtown, you notice a rash. Without leaving, you connect to your doctor via video conference, and a prescription is called in. Everything related to your healthcare can be done on your smartphone, and you can text. You can make appointments the same day, and you feel welcome when you walk in. If you need to see a specialist right away, it is a matter of online scheduling, and an appointment is available that day.
Middle aged people would like a friendly healthcare setting where they can be sure their information is on hand at the time of every appointment, that their values and priorities are respected, and that they are equipped to manage health risks like being overweight or having high blood pressure. All of their specialists would be communicating proactively with them, in a language they can understand, providing a clear care plan and sharing information with the primary care team. There would be one place to logon to see a single, organized medical record that is shared between the patient and the primary care team. This record would be accessible electronically from anywhere! The doctors would communicate with eachother. Patients would have the tools and resources they need to work toward their best health, including information on diet and exercise, access to a doctor or health provider with whom they have a relationship, advice on apps, and support for their own health goals. Time constraints, barriers to care, and cultural differences would be appreciated.
Older adults might imagine video conferences from their home to the doctor's office, and having only the help that is needed to maintain best independence. Their kids, health providers and caregivers would treat them with dignity and respect their decisions. Help would come fast when it is needed. They would not be alone. Their kids and grandkids would spend time with them and be kind. They would have an ontime ride. Their medication costs would not interfere with basic needs, and they would have access to healthy and nutritious food even after reaching an advanced age. There would be exercise programs available in every neighborhood, including classes to improve balance. Whole communities would work toward promoting better health, and older adults would teach classes.
Healthcare would be at home mostly for older adults who don't want to ever go to the hospital again. Doctors and their teams would wrap around patient priorities and help families to support these values. There would be guidance at each step of the way as decisions change and families work out plans. Patients, families, caregivers and the healthcare team would have deep and mutual respect. Elders would be honored and not rushed. Their stories would be known. Their wisdom would be tapped and their resilience appreciated. They would not have to work to keep their information organized, and they would not have too many doctors or interventions. Not too much, not too little. Just right.
For the past 5 years, we have been examining the healthcare system at Green Spring Internal Medicine. It is as if we went into the backyard looking for a treasure and unearthed a fire breathing dragon. Many of our patients and family members are experiencing trauma in the form of discoordinated and poorly communicated care. It is hard for patients to understand that their doctors are not all interconnected in an inter-communicating electronic health record system. It may take months to get an appointment with a specialist, if the appointment is even able to be made. Phone trees are complex and unwelcoming, and doctors may not call back.
We are trying to be the change, first as a PCMH (or patient-centered medical home) and then as a member of a larger network of independent primary care providers in an ACO. We are moving in the direction of telemedicine and are leveraging the Patient Portal and Healow app to bring technology to our patients' fingertips. We've incorporated fitness trackers and multilingual patient resources. We are also leveraging our entire team of certified medical assistants to help our older adults coordinate their care. In addition, we have formed a partnership with CareFirst to coordinate the healthcare and provide resources to more complex patients. We are also asking our patients about their own health goals or priorities and trying to wrap around them. The world is far from perfect, but we have been doing our part to shape healthcare into something more beautiful.
