The profound illness of his friend and fellow professor Susan Dick has moved Duncan Sinclair to ponder the physician world of his work colleagues, versus the team healthcare model championed by CAPCH. Another aspect of People-Centred care would have caught sight of Susan’s condition before it became critical: namely, universal Electronic Health Records available to the patient as well as to her clinic team.
“An intelligent person like Susan Dick, having been concerned with her health her whole life, had she had access to the kind of record-keeping system that would’ve detected change over time – changes in her respiratory or heart or blood sugar rate or whatever it is – she would’ve been able to see from the trends a deterioration. It’s that awareness.
“She would naturally have a subjective appreciation that after her walk round the block she had a little more trouble breathing than last week or last month; but she may have thought, ‘It’s just today’. A record tracking these details over time would’ve triggered an earlier awareness of something going on – with someone with more knowledge than herself to interpret the data for her.”
Duncan adds thoughtfully: “Access to your own ongoing records would be very important in healthcare reform, and the technology is now in place where we could build that kind of informational record. The technological generation and the modern availability of information is changing how we view our options. For instance the primary asset of most universities was the library, because the primary repository for the world’s information was in things called libraries. Now, the world library is available to every person with a computer!
“In health, the medical/sickness knowledge resided largely in physicians’ heads. Now it’s available, really, for those who want to search it out on the Internet. So we’re moving from a monopoly of information to the abandonment of that monopoly, and that’s a very good thing. Of course, then you need a degree of experience to interpret that information and come out with a helpful answer, but physicians will no longer hold the same degree of power as before.
“Many physicians are working more in teams, mostly in primary care rather than hospitals. People tend to believe that not being sufficiently People-Centred can be laid at the feet of physicians, but that’s not true – many are very people-oriented and regret very much that the economic model under which most of them operate is such that it puts heavy constraints on the amount of time they can spend listening, and the time they can take to communicate. Because you’re working within a model based on fees-for-services – ‘piecework’. Then, if you spend that much time with patients, you can’t make money!
“Susan had excellent care. Which she appreciated. The care was less personal than anybody would really want, but the practicality of running a highly sophisticated hospital, particularly an ICU, doesn’t allow a lot of familiarity between patients and caregivers. Physicians in ICU are always torn by that.
“There’s very good evidence that’s been generated by HMO’s (Health Maintenance Organizations), providers of healthcare benefits in the States, very good ones. The evidence is very plain that by really working at the early detection/prevention end of illness, the cost savings are very substantial over the whole of the system.
“At the Veteran’s Association, healthcare was transformed totally. Given that this group includes a lot of seniors, a very vulnerable sector of the population, they focused on primary care rather than hospital care – as one friend says, the approach has been transferred ‘from worst to first’.
“The evidence is very plain that, done right over a whole population, you can save substantial amounts of money spent now at solving serious problems, if you treat them when trivial, at the beginning. The model or concept of a healthcare team works – when it’s paired with Electronic Health Records.”