“It is actually over 30 years that I have been practicing what we used to call ‘a humanistic approach to care’,” says CAPCH president and co-founder Vaughan Glover. “It has been 26 years since I consciously tried to take what I have learned through dentistry and try to make a difference in our health system as a whole.”
Ask him what his years both practicing and living for people-centred health care have taught him about various stakeholder groups in health care, and Vaughan has a ready list. First of all – about patients.
“People always make the best decisions for themselves – and it will be based on their values and realities.
“Never prejudge people or assume what they do or do not want to hear or know about their health. Every person has the right to know all their options and make choices based on all the facts. And 100% of the time, when you think you know all there is to know about someone, they surprise you!
“Information must be given to people in a manner they can understand. I have people on my team who are really superior at communicating. So our client coordinator sits down and makes sure a patient has understood in their responses that they get it. The whole issue of lexicon rises here. If I’m under pressure and focused on diagnosis and treatment planning, then I always have the communicator in the room. When she senses the client is confused, she asks a question on their behalf.
“If your goal is to help, the only way that happens is if there’s a trusting relationship. Care is relationship-based – you develop a relationship with the person needing care based on trust. It takes a long time to actually help a person if you aren’t building trust.
“Everyone is a human being in a people-centred system. It’s not just the patient. If the nonverbal in the office is ‘They don’t care about each other’, the conclusion is ‘they won’t care about me’. At any health office, we should be caring for one another as much as we’re caring for people who come to see us. How can you care for someone else when you’re working from an empty basket?”
Vaughan is also concise about what his years in people-centred health care have taught him about himself.
“How blessed I am to live in a country where even a dad, husband and dentist from Arnprior can make a difference! I appreciate so much what we’ve been given. It’s a blessing we care enough about one another that we’re willing to pool our resources so that we can have a level of care. But saying you’ll provide something that then takes so long to get you die before you get it, is not responsible. I’ve learned tremendous responsibility. We can approach health care differently and we have to approach it differently.”
He is thoughtful in pondering what he’s learned about physicians and care providers.
“I certainly am concerned about how they select people to be caring physicians or if they even do select for caring physicians. It’s been largely about academics, then people best suited to care AFTER that. I have huge issues there.
“When it comes to knowing what is best for a person’s health, physicians are an incredible group of people who fundamentally believe in people-centred care and want to support health rather than just treat illness. But they are forced to work in a system that is all about illness and only rewards fixing. It’s all about fixing – 80% of modern medicine is treating symptoms, not causes. To figure out what caused a back pain, say, is very different. Headache pain, muscle pain, depression, mental disorders – it takes nothing to put someone on an antidepressant, but to sit down and come to grips with what’s actually going on in their life, what might be aggravating the depression – there’s just no incentive in the system for that! Symptoms, not causes; treating illnesss, not building health; rewarding treatment rather than supporting the whole person… So many caring physicians have been beaten down so many times trying to change the system – and they just don’t have the time to persevere and still earn a living.”
For Vaughan the subject of politicians and the politics of healthcare is a thornier subject. He has weathered a lot of distress over the political will – or lack of it – when faced with evolving healthcare in this country, and he has become extremely succinct.
“Most politicians know very little about health or health care and almost all make decisions based on what will win the next election. Again, most politicians start off caring and wanting to make a difference, but their system only rewards them for winning popularity contests.”
However Vaughan is a fundamentally optimistic person, and tends to focus on the positive. In that vein, he’s adamant on one score: shared electronic health records are absolutely mandatory in a people-centred health care revolution.
“Shared Electronic Health Records (SEHRs) enable a needed paradigm shift in health information and power. Access to one’s own health information wherever and whenever a person wishes, and being able to share their health information with whomever they wish, is the foundation for a person’s journey to wellness.
“One of the most exciting things at CAPCH right now is to be making progress on a Connected Wellness Platform that can help make SEHRs happen: where a person has access wherever, whenever, they want to their own health information, test results, whatever, and they hold the reins on who else gets it. It enables providers to collaborate around a patient, because they’re all connected through the patient – not through the doctor.”
Of course, practicing and living for people-centred health care has changed the way Vaughan approaches his own or a loved-one’s appointment with a doctor. “When Betsy had an emergency surgery, we talked with the doctors and put our trust in them doing the right things to save her life in the middle of the night in July 2010. It gave me tremendous respect for the doctors who openly admit that they are human beings and all they can do is their best with what they know at the time. Like each of us, they make informed decisions; monitor; and if they need to change course, they discuss and make the next decision.
“But other than for life-and-death or emergency health issues, I never go to a doctor for treatment. I always go for information and a physician opinion. I make sure they understand that I need time to process – and that I will make the decision as to who does what and when.
“I also always ask whether they are treating a cause or treating a symptom. Most care that is provided in our system is for symptoms. I make it very clear that my goal is to treat the cause of the problem, and this can totally change your relationship with your doctor!
“I also have to be prepared to accept that it can take time and energy to figure out causes. Most physicians haven’t even thought about it, but I think that knowing whether you’re treating causes or symptoms should be a fundamental piece in health care. Everyone should know. The reality is, 90% of prescriptions handed out are treating symptoms. The idea is ‘Get them through an acute system so they’re off the waiting list’. … Till they come back, and the system is so overbooked they can’t get in!
“The analogy is this: imagine you have a rusted-out car, and it’s got 40 rust spots and one of them caught your eye. So you go to the mechanic and the guy says, ‘Okay, I’ll fix that spot’ – and you have to keep coming back until all the spots are filled in. Meanwhile nobody is actually looking at the causes of the rust. Does your car need an oil guard it’s not getting? Should you be washing your car more often? How much driving are you doing near salt, and can you change that? – Those would be treating the causes, not the symptom.
“If a case comes into my own office that is very complex, I do the consultation, but I also tell the person to go and get another opinion. Then I want to talk to that other doctor, and become clear on cause, then start a treatment plan. Otherwise, if you only treat symptoms, and never try to address causes, people become discouraged.”
Thirty years ago when Vaughan started his people-centred care journey, his was a voice in the wilderness. But signs of change are everywhere. Vaughan finds many encouraging experiences nowadays that tell him people-centred care is making needed inroads in our healthcare system.
“I recently served on an advisory board for a Health Canada project being headed up by Saint Elizabeth Health Care (SEHC). It was a review of the literature and research on Client-centred Care in Home and Community. There were 247 pieces of research completed since 1998 – and all unequivocally support the evolution to a person-centred care system.
“The other piece of our work on that advisory board is that we did a review of all the organizations and groups who claim to be ‘people/person/client/patient –centred’. The list was 74 pages long and growing. Eight years ago when I first met with a group to decide what we would call CAPCH, the term ‘people-centred’ was virtually unheard of! Today, every major stakeholder group and grassroots organization is getting the message that each person is unique and wants to be treated as such.”
Experiences like this keep Vaughan excited and motivated on his journey towards universal Canadian people-centred health care. But, he adds, “the number one reason is people: the opportunity to meet and work with incredible people and to know that I am truly making a difference in the lives of others.”