There's no shortage of contentious issues in American public life and few as thorny as healthcare policy. We will soon spend 20% of our gross domestic product on health, and yet we hardly seem to agree on the best path forward.
Making matters worse, this tremendous investment of resources often fails to reach the places that require it most. Think about the savings that would accrue if we spent more of those resources addressing the social determinants of health, which include all aspects of one's background. And by 2035, America will have 78 million citizens age 65 or older, many of whom will need care for multiple chronic health conditions. It's time to look for better approaches.
There's a simple solution: advance humanism in healthcare, which as defined by the Arnold P. Gold Foundation characterizes “a respectful and compassionate relationship between physicians, members of the healthcare team and their patients.” Humanism reflects active listening, empathy and professionalism in the medical encounter, which shouldn't be too much to ask.
As we face top killers like cancer and heart disease, where 80% of outcomes depend on factors outside of the clinical component, an expanded approach to healthcare delivery that incorporates culture, spiritual beliefs and health literacy is critical to improving outcomes.
Some may think a philosophical outlook is too soft a remedy for modern medical crises. But it already guides and informs many substantial changes that have helped heal patients, reduce costs and improve employee satisfaction.
Consider Kathy, a 49-year-old empty nester who changed doctors and got a thorough physical after years of neglecting her own health. Alarmed by fatigue and decreasing exercise capacity, she saw her doctor who, after a normal EKG, dismissed her family heart history, and told her all was OK and she just needed to lose weight. No extra steps were recommended.
Not satisfied, Kathy consulted with a cardiologist specializing in women's heart health, who instead of dismissing her concerns did something else: she listened. She considered Kathy's family history, ethnicity and health phobias, and ordered another exam of Kathy's heart. This time, the test showed Kathy had non-obstructive coronary artery disease.
The approach proved informative in both diagnosing the problem and evaluating Kathy's risk for heart disease. The physician engaged Kathy as a partner in her care and co-created a heart healthy living plan with lifestyle changes and medication to control her blood pressure, a potent risk factor for heart disease. She referred her to a nutritionist and advised her to take up yoga. Soon, Kathy was losing weight and getting in shape to lower her heart attack risk.
The approach benefited both Kathy's health and the system's bottom line. Open-heart surgery is costly, requires a long recovery period and prolonged hospitalization. Controlling heart disease risk factors and avoiding surgery with medication, exercise and portion control is certainly less expensive and traumatic. But for such an approach to work more broadly, patients need to be considered partners who can help customize their care plan in conjunction with clinicians, considering cultural sensitivities and personal choices.
And what's good for patients is good for employees, too. In 2018, Northwell surveyed 68,000 team members, and asked if their work had meaning beyond a mere “job.” About 85% answered “yes,” an indication of job satisfaction and recognition that the healthcare delivery model must include a humanistic approach where the patient is a partner in their care.
If we want to reap the benefits of the humanistic approach and continue to see it grow, then all members of the healthcare team need to be constantly educated on best practices and how to enhance the art of communicating with patients to ensure the best outcomes. It may sound like a mere nicety, but as anyone who cares for patients knows, eliminating guesswork early on results in more efficient, comprehensive treatment.
As we continue to grapple with ways to improve health outcomes, let's reignite this most personal part of healthcare and bring medicine back to its origins as the practice of human beings helping each other heal.
