The Cultural Transformation of Healthcare

The Cultural Transformation of Healthcare


– HI. I’M TRACEY GAUDET. I’M THE DIRECTOR OF THE OFFICE
OF PATIENT CENTERED CARE AND CULTURAL TRANSFORMATION, AND IT’S REALLY EXCITING FOR ME
TO BE ABLE TO TALK TO YOU TODAY. WHAT WE WANT TO TALK ABOUT IS THE CULTURAL TRANSFORMATION
OF HEALTHCARE, THE FUTURE OF VA HEALTH CARE,
AND WHERE WE’RE GOING. THE VA IS INNOVATING AN ENTIRELY
NEW APPROACH TO HEALTH CARE THAT TAKES US FROM OUR CURRENT
HEALTH CARE SYSTEM, WHICH IS PREDOMINANTLY
A PROBLEM-BASED, “FIND IT, FIT IT” APPROACH– AND I’LL SAY MORE ABOUT
WHAT I MEAN BY THAT– TO ONE THAT IS PERSONALIZED,
PROACTIVE, AND PATIENT-DRIVEN. SO FIRST OF ALL,
TO SAY A LITTLE BIT MORE ABOUT OUR PROBLEM-BASED
APPROACH, I WAS TRAINED AS A PHYSICIAN
THAT MY JOB WAS TO FIND THE DISEASE,
DIAGNOSE IT, CURE IT WHEN I COULD, AND WHEN I COULDN’T CURE IT,
TO MANAGE IT. THAT WAS THE JOB, VERY MUCH
A “FIND IT, FIT IT” STRATEGY, BUT THERE’S A LOT OF PLACES
WHERE THAT FALLS SHORT, AND I ASKED RECENTLY SOME
VA FOLKS TO GIVE ME SOME STORIES TO REFLECT ON WHEN THEY MAY HAVE
SEEN THE LIMITATIONS OF THIS
“FIND IT, FIT IT” STRATEGY. ONE WOMAN WAS VERY QUICK
TO THINK OF A STORY THAT SHE ACTUALLY SAID WAS A
LITTLE PAINFUL FOR HER TO SHARE PRIMARILY BECAUSE
IT WAS ABOUT A VETERAN WHO WAS IN A DYING PROCESS
IN HOSPICE CARE AND HE HAD SOME PAIN. HE HAD A FAIR DEGREE OF PAIN. SHE WAS DOING HER JOB,
AND SHE WAS FOCUSED ON REDUCING THAT PAIN
IN ANY WAY SHE COULD AND QUITE CONSUMED WITH TRYING
TO COMPOUND DIFFERENT APPROACHES AND PHARMACEUTICALS TO GET
HIS PAIN TO A LOWER LEVEL. HE TOLD HER AFTER A WHILE– IT TOOK HIM A WHILE
TO GET HER ATTENTION– THAT FOR HIM IN THAT EXPERIENCE, HE ACTUALLY DIDN’T
WANT HIS PAIN LEVEL LOWERED. HE FELT THAT IT WAS AN IMPORTANT
PART OF HIS DYING PROCESS TO GO THROUGH THAT EXPERIENCE, AND HE WAS ACTUALLY FINE
WITH EXACTLY THE WAY IT WAS. HER REFLECTION WAS THAT IT WAS
KIND OF ALARMING TO HER THAT SHE WAS SO FIXATED ON WHAT SHE THOUGHT
SHOULD HAVE BEEN THE GOAL THAT SHE ACTUALLY MISSED WHAT
WAS IN THE BEST SERVICE OF HIM. ANOTHER WOMAN SHARED A STORY
ABOUT A PATIENT WHO HAS BIPOLAR DISEASE AND,
FOR SOME REASON, YOU KNOW, SOMETIMES HE’S STABLE
AND SOMETIMES HE’S NOT, AND HE WENT INTO A PHASE
WHEN HE WAS NOT STABLE, AND HE NEEDED TO BE HOSPITALIZED
IN THE VA. SHE WENT ON TO TALK ABOUT
HOW HE KEPT KIND OF “ESCAPING” OR LEAVING THE SYSTEM,
AND THEY’D SPEND MONEY AND TIME TRYING TO FIND HIM,
BRING HIM BACK, AND THIS WENT THROUGH
A COUPLE OF CYCLES UNTIL SHE WENT TO VISIT HIM AND REALLY ASKED HIM,
“WHAT’S GOING ON?” WELL, IT TURNS OUT THAT
HIS FATHER HAD RECENTLY DIED, AND HE WAS TRYING,
DESPERATELY TRYING, TO GET BACK TO THIS CABIN
WHERE HE HAD SPENT A LOT OF TIME WITH HIS FATHER WHEN HE WAS
GROWING UP AS A CHILD. SHE REFLECTED THAT AS A STORY. EVERYBODY WAS TRYING
TO DO THE RIGHT THING– TAKING CARE
OF HIS BIPOLAR DISEASE, KEEPING HIM IN THE HOSPITAL– BUT, AGAIN, WITH OUR FOCUS ON
FINDING AND FIXING THE PROBLEM, ACTUALLY MISSED THE OPPORTUNITY TO REALLY HELP THIS MAN
IN THE BEST WAY. ANOTHER EXAMPLE THAT WAS SHARED
WAS A PATIENT THAT WAS SUFFERING
WITH DEPRESSION AND HAVING INCREASING SYMPTOMS
OF DEPRESSION AND SOME SUICIDAL IDEATION. THE WOMAN THAT WAS
SHARING THIS STORY SAID SHE WAS ASKED TO SEE
THE PATIENT, AND THERE WAS SOME EXPECTATION
THAT SHE’D PROBABLY ADD SOME ANTIDEPRESSANT
OR CHANGE HIS MEDICINES AROUND, BUT SHE TOOK ANOTHER APPROACH, AND SHE ACTUALLY
ASKED THIS GENTLEMAN, WERE THERE TIMES IN THE DAY
OR THE NIGHT WHERE HE WASN’T FEELING
SO SEVERELY DEPRESSED? WERE THERE TIMES WHEN HE WASN’T
THINKING ABOUT SUICIDE, AND WHAT WAS HE THINKING ABOUT,
AND HE WAS QUICK TO SAY YES. AS A MATTER OF FACT,
THERE WERE THOSE TIMES, AND IT WAS REALLY
ABOUT HIS GRANDCHILDREN AND WHAT A SOURCE OF JOY
THEY WERE, AND WHEN HE WAS FEELING
CONNECTED TO THOSE THOUGHTS OR TO THOSE MEMORIES, HE WASN’T
FEELING DEPRESSED OR SUICIDAL. SO THEY MADE A STRATEGY
WHICH WAS ACTUALLY ABOUT HOW DO YOU DIAL UP THE JOY
AND THE SOURCE OF HAPPINESS RATHER THAN ONLY COMBATING
THE DEPRESSION, SO VERY DIFFERENT APPROACH. ALL OF THESE ARE EXAMPLES
OF A PERSONALIZED APPROACH RATHER THAN
THE “FIND-IT, FIX-IT,” DISEASE-BASED CARE
THAT WE’RE SO TRAINED TO DO. SO IF YOU THINK ABOUT
EVEN THE NAMES OF OUR DRUGS, WE HAVE ANTIBIOTICS. WE HAVE ANTIHYPERTENSIVES.
WE HAVE ANTIDEPRESSANTS. WE’RE FIGHTING A WAR.
IT’S THEM AGAINST US. TALK ABOUT REACTIVE.
FIND IT, FIX IT. IT’S WARFARE. THAT’S THE PARADIGM WE WERE
TRAINED IN PREDOMINANTLY, AND AGAIN, I’M MAKING
A LOT OF GENERALIZATIONS, BUT IF WE’RE LOOKING AT THE
OVERALL APPROACH TO HEALTH CARE AND MEDICAL CARE
IN THIS COUNTRY, THESE ARE THE CHARACTERISTICS IN THE WAY WE’RE TRAINED
AND WHAT WE’RE GOOD AT. SO THAT’S
THE PERSONALIZED PIECE. THAT’S WHAT IT MEANS TO SHIFT
TO A MORE PERSONALIZED APPROACH. THE OTHER CHARACTERISTIC WE TALK
ABOUT IS BEING PROACTIVE. NOW, THAT’S AN INTERESTING
PIECE, TOO. WHAT DOES THAT MEAN? FOR SOME PEOPLE, IT MEANS,
AH, PREVENTING DISEASE, AND I WANT TO MAKE SURE
PEOPLE UNDERSTAND THAT YOU CAN BE PROACTIVE
AT EVERY PHASE ALONG ONE’S LIFE. YOU CAN BE PROACTIVE
ABOUT DEATH. SO WHAT DO I MEAN BY THAT? HOSPICE DOES THIS BEAUTIFULLY,
WHICH IS, YOU CAN SIT BACK IF YOU’RE GIVEN A TERMINAL
ILLNESS AND WAIT TO DIE, OR YOU CAN ACTUALLY ENGAGE
IN A PROCESS THAT THINKS ABOUT HOW WOULD
I WANT THAT EXPERIENCE TO BE, HOW WOULD THAT BEST SERVE ME
IN MY LIFE AND IN MY DEATH, AND HAVE A VERY PROACTIVE
APPROACH TO DESIGNING THAT. ANOTHER GREAT EXAMPLE
IS HEADED INTO SURGERY. MOST OF US, IF AND WHEN
WE’RE TOLD WE NEED SURGERY, IT’S A SCARY THING. WE CAN HAVE A REACTIVE
PROCESS TO THAT WHERE WE JUST KIND OF
WAIT SCARED TILL THEY, YOU KNOW, WHEEL US DOWN
AND CUT US OPEN, VERY FRIGHTENING, OR WE CAN TAKE
A PROACTIVE APPROACH TO PREPARING FOR THE SURGERY. WE CAN BE MENTALLY PREPARED. WE CAN CHANGE THINGS IN OUR DIET
OR OUR FITNESS IF WE HAVE TIME TO DO THAT. WE CAN USE MIND-BODY APPROACHES
TO REDUCE PAIN AND ANXIETY. THERE ARE A LOT OF THINGS
WE CAN DO THAT NOT ONLY AFFECT
OUR EXPERIENCE OF THAT HEALTH CONDITION
AND PROCESS, BUT ALSO THE ACTUAL OUTCOMES. ANOTHER GREAT EXAMPLE IS CANCER. MANY, MANY PEOPLE KNOW OR HAVE BEEN THROUGH
CANCER DIAGNOSIS AND TREATMENT. IT’S INCREDIBLY FRIGHTENING, AND THERE’S KIND OF
A SAD STORY, IN A WAY, FOR ME WHICH IS A CONVERSATION I HAD WITH THE HEAD
OF RADIATION ONCOLOGY AT A LEADING ACADEMIC
INSTITUTION, AND HE SAID TO ME, HE SAID–
AND HE WAS SO SERIOUS– HE SAID, “YOU KNOW THE PROBLEM
WITH PATIENTS THESE DAYS? “THEY ALWAYS WANT TO KNOW
WHAT THEY CAN DO, “AND I’M ALWAYS TELLING THEM
THERE’S NOTHING YOU CAN DO. JUST RELAX, WE’LL DEAL WITH IT,” AND THAT’S A FRIGHTENING THING
FOR ME TO SAY. FIRST OF ALL, IT’S NOT TRUE. THERE ARE MANY THINGS
THAT PEOPLE CAN DO THAT AFFECT BOTH THE DEGREE TO WHICH THEY
MIGHT SUFFER WITH SYMPTOMS OR SIDE EFFECTS AND ALSO
THE COURSE OF THEIR DISEASE, BUT MORE IMPORTANTLY, IN A WAY,
IS THE HARM THAT THAT KIND OF A STATEMENT
DOES FOR SOMEONE FACING THAT DIAGNOSIS. “THERE’S NOTHING YOU CAN DO”?
JUST SIT BACK”? HOW FRIGHTENING. SO A PROACTIVE APPROACH
TO A DIAGNOSIS OF CANCER AND TREATMENT IS TO EXPLORE
WHAT DOES THAT MEAN TO YOU. HOW DOES THAT AFFECT YOUR LIFE
AND CHANGE WHO YOU ARE? WHAT APPROACHES COULD YOU PUT
INTO PLACE, WHETHER THAT’S MIND-BODY
APPROACHES OR NUTRITION OR OTHER MODALITIES,
THAT COULD HELP REDUCE THE RISKS OF SIDE EFFECTS AND IMPROVE
YOUR IMMUNE SYSTEM AND YOUR POTENTIAL OUTCOMES. SO THOSE ARE ILLUSTRATIONS
OF WHAT IT MEANS TO BE PROACTIVE IN YOUR APPROACH
TO YOUR HEALTH AND WELL-BEING. LASTLY AND–IN SOME WAYS, IN
MY OPINION–THE MOST IMPORTANT, WHAT ABOUT
THIS PATIENT-DRIVEN THING? WHAT DOES THAT MEAN EXACTLY? DOES IT MEAN SIMPLY TAKING THE
VETERAN’S OPINIONS INTO ACCOUNT? I’D SAY IT’S
A LOT MORE THAN THAT. WE SHOULD CERTAINLY
BE DOING THAT, BUT WHEN IT’S PATIENT-DRIVEN,
IT MEANS THE WHOLE THING BEGINS AND ENDS WITH
WHAT MATTERS TO THE VETERAN. THIS IS INCREDIBLY IMPORTANT
BECAUSE, FOR THE VAST MAJORITY
OF HEALTH CARE, IT REALLY DOES DEPEND
ON THE INDIVIDUAL’S COMMITMENT AND INVESTMENT IN THEIR OWN
HEALTH AND THEIR OUTCOMES. SO UNLESS IT BEGINS
WITH WHAT MATTERS TO THEM, WE’RE NOT GONNA GET VERY FAR. A COUPLE OF QUICK STORIES
ABOUT THAT. WELL, MAYBE NOT SO QUICK. DON BERWICK,
WHO SOME OF YOU MAY KNOW, TELLS A WONDERFUL STORY
ABOUT THIS KIND OF THING. HE WAS TALKING ABOUT AN ISSUE
HE’D HAD WITH HIS KNEE AND SURGERIES HE’S HAD
IN THE PAST SPANNING 30 YEARS OF HIS LIFE AND IT CAME TIME FOR HIM TO
HAVE A SURGERY, ANOTHER SURGERY, AND HE WAS REFLECTING ON THAT BECAUSE NONE OF US LIKE TO HAVE
SURGERY IF WE CAN AVOID IT, AND HE WAS REFLECTING ON,
“WHY AM I HAVING THE SURGERY?” WHAT MATTERS HERE ENOUGH
THAT I WOULD HAVE SURGERY?” AND HE THOUGHT ABOUT IT,
AND HE SAID, “YOU KNOW WHAT? PAIN.
I HAVE PAIN. “I REALLY DON’T WANT
TO LIVE WITH PAIN. THAT’S WHAT MATTERS,” AND HE GAVE THAT SOME THOUGHT,
AND HE THOUGHT, “WELL, THAT’S TRUE. “THAT IS TRUE, BUT LET’S GO
A LITTLE BIT DEEPER, YOU KNOW? WHAT DO I REALLY WANT?” THOUGHT ABOUT THAT,
GAVE IT SOME THOUGHT, AND WENT, “YOU KNOW, WHAT I REALLY WANT
IS TO BE ABLE TO BE MOBILE, “TO MOVE AROUND FREELY
IN MY LIFE AND NOT BE LIMITED
IN THE WAYS I CAN MOVE.” HE THOUGHT ABOUT THAT,
WENT, “YEAH. THAT’S RIGHT,” PUSHED IT A LITTLE FURTHER. “WHAT DO I REALLY, REALLY WANT?” AND HE BEGAN TO THINK ABOUT HOW ONE OF THE THINGS
HE LOVES IN LIFE IS SKATE-SKIING, WHICH IS A FORM
OF CROSS-COUNTRY SKIING, AND HE CAME TO FIND OUT
WHEN HE THOUGHT ABOUT THAT THAT THAT WAS SOMETHING THAT HE
LOVED AND BROUGHT JOY TO HIM, AND HE REALLY DIDN’T
WANT TO LIVE A LIFE WITHOUT IT IF HE COULD, AND HE SAID, “YEAH. THAT’S WHAT
I REALLY, REALLY WANT.” THEN HE TOOK IT
ONE STEP EVEN FURTHER. “WHAT DO I REALLY, REALLY,
REALLY WANT?” AND HE TALKED ABOUT
THE EXPERIENCE HE HAS WHEN HE GOES SKATE-SKIING
AND WHAT IT’S LIKE TO BE IN AN ENVIRONMENT
IN NATURE WITH THE SILENCE IN THIS GROVE OF CEDAR TREES
WITH THE RED SQUIRREL, AND HE DESCRIBES
THIS WHOLE THING SO BEAUTIFULLY, AND HE TALKED
ABOUT HOW SIGNIFICANT THOSE MOMENTS ARE FOR HIM. HE SAID, “THAT’S WHEN I REALIZED “THAT THAT’S WHAT I REALLY,
REALLY WANT. “THAT’S WHY I WANT TO
GO THROUGH THE SURGERY. THAT’S WHAT’S WORTH THE PAIN AND
THE TRAUMA OF THAT EXPERIENCE,” AND THEN HE WENT ON TO SAY THAT
“I REALIZE THERE IS A DEEP “AND MEANINGFUL CONNECTION
BETWEEN MY KNEE AND ME, “AND NOT ONE HEALTH CARE
PROVIDER OF 30 YEARS KNOWS THAT ABOUT ME,
AND IT’S NOT THEIR FAULT.” HE MAY NOT HAVE KNOWN THAT
ABOUT HIM. WE AREN’T TRAINED TO ASK
THOSE QUESTIONS, BUT THE BOTTOM LINE IS,
UNLESS WE HELP PEOPLE PEEL AWAY THE LAYERS OF WHAT
REALLY, REALLY MATTERS TO THEM, THEY’RE NOT GOING TO ENGAGE
FULLY IN THEIR HEALTH OR BEING PROACTIVE
ABOUT THEIR HEALTH CARE. ANOTHER GREAT EXAMPLE
IS A GENTLEMAN WHO CAME IN, LONG-TIME SMOKER,
KNOWS ALL THE RISKS OF SMOKING, HAS BEEN EDUCATED. IT’S NOT AN ISSUE
OF INFORMATION. YOU KNOW, THERE’S ALWAYS
THIS BIG GAP BETWEEN INFORMATION
AND BEHAVIOR. SO HE SAID,
“I KNOW ABOUT THE RISKS. “I KNOW I SHOULD STOP SMOKING. “I’M NOT GONNA,
SO GIVE UP THE HOPE. DON’T EVEN GO THERE.” SO WE DIDN’T, BUT WE ENGAGED HIM
IN THIS PROCESS OF EXPLORING WHAT REALLY, REALLY
MATTERS TO HIM, WHAT DID HE WANT HIS HEALTH FOR,
WITHOUT AN AGENDA OF OUR OWN, BUT REALLY TO HELP HIM
EXPLORE THAT, AND WHEN HE REALLY THOUGHT
ABOUT AND REFLECTED ON IT AND PEELED AWAY THESE LAYERS,
HE REALIZED THAT WHAT HE REALLY
LOVED IN LIFE WAS HIS RELATIONSHIP
WITH HIS GRANDSON. HE WAS ABOUT 7 AT THE TIME, AND HE WAS A PRIMARY CARE
PROVIDER FOR HIS GRANDSON, AND HE LOVED THAT RELATIONSHIP. WE ASKED HIM TO THINK ABOUT
WHAT THAT WOULD BE LIKE IN 5 YEARS, IN 10 YEARS,
IN 15 YEARS, WHAT WOULD HE LIKE IT TO BE, AND WERE THERE ANY THINGS
THAT WERE IN THE WAY OF THAT WHICH HE WANTED, AND HE CAME TO THE CONCLUSION
IN DOING THIS REFLECTION THAT HIS SMOKING
WAS ACTUALLY A BARRIER. IT WAS A BARRIER TODAY IN
LIMITING SOME OF THE ACTIVITIES HE COULD DO BECAUSE HE WAS
HAVING RESPIRATORY ISSUES. IT WAS A BARRIER THAT
HE DIDN’T LIKE THE FACT THAT HIS CLOTHES SMELLED LIKE
SMOKE AND HE WAS IN SOME WAYS MODELING THIS BEHAVIOR
FOR HIS GRANDSON. IT WAS CERTAINLY AN ISSUE
WHEN HE THOUGHT ABOUT WHAT HIS HEALTH
WOULD BE LIKE AND HIS VITALITY WOULD BE LIKE
5, 10, 15 YEARS OUT, AND HE REALIZED FOR THE REASONS
THAT MATTERED MOST TO HIM, NOT BECAUSE OF PICTURES
OF DISEASED LUNGS OR STATISTICS, BUT BECAUSE OF HIS RELATIONSHIP
WITH HIS GRANDSON. HE SAID, “YOU KNOW WHAT?
I WANT TO QUIT.” THEN WE COULD STEP IN AND HELP. OUR TOOLS COULD THEN
BE SUCCESSFUL. IT’S A REALLY WONDERFUL
ILLUSTRATION, AND LAST ILLUSTRATION I WANT TO
SHARE, BECAUSE THIS IS IMPORTANT WITH CHRONIC ILLNESS
SUCH AS TOBACCO USE AND ISSUES LIKE THAT, WITH AN ISSUE LIKE SURGERY
THAT WE TALKED ABOUT, ANOTHER EXAMPLE THAT WAS GIVEN
TO ME, ACTUALLY, WHEN I WAS HAVING A MEETING
WITH SOMEBODY IN THE VA WHEN I WAS JUST NEW
TO THE SYSTEM. I WENT TO MEET WITH THIS PERSON
AND SHE WASN’T THERE, AND HER STAFF SAID, “OH, WE’RE SO SORRY
YOU DIDN’T GET THE MESSAGE. “SHE REALLY WANTS TO MEET
WITH YOU, BUT SHE’S IN INTENSIVE CARE,” AND I THOUGHT FOR A MINUTE
BECAUSE I KNEW THIS PERSON WASN’T
A MEDICAL PROVIDER. I SAID, “SHE IS INTENSIVE CARE?” THEY SAID, “YEP.
SHE’S ON A RESPIRATOR BATTLING BREAST CANCER, BUT SHE
REALLY WANTS TO MEET WITH YOU.” SO THE FIRST THING THAT
FREAKED ME OUT A BIT WAS LIKE, “REALLY?” LIKE, I’M HOPING
SHE’S NOT LYING THERE THINKING ABOUT MEETING WITH ME, BUT YOU KNOW WHAT WAS AMAZING
TO ME, ABSOLUTELY AMAZING? THEY SAID, “NO, NO. “SHE WANTS TO ME WITH YOU.
SHE’S ANXIOUS TO MEET WITH YOU. “WE’LL GET YOU BACK
ON HER CALENDAR JUST AS SOON AS SHE’S BACK,”
AND I THOUGHT “OK,” YOU KNOW? 3 WEEKS LATER,
I HAD AN APPOINTMENT WITH HER, AND I THOUGHT
IT HAD TO BE A MISTAKE. I GO TO HER OFFICE. SHE’S THERE,
AND SHE’S LOOKING GREAT, AND I SAT DOWN WITH HER,
AND I STARTED TALKING TO HER ABOUT THIS VISION FOR THE FUTURE
OF HEALTH CARE, AND SHE SAID, “CAN I STOP YOU
FOR A MINUTE?” AND I SAID, “SURE. OF COURSE.” SHE SAID, “I DON’T KNOW IF
YOU’RE AWARE, BUT 3 WEEKS AGO, I WAS IN THE INTENSIVE CARE UNIT
ON A RESPIRATOR,” AND I SAID I WAS AWARE. SHE SAID, “LET ME TELL YOU
ABOUT THIS.” SHE SAID, “THE FIRST THING
YOU NEED TO KNOW ABOUT ME IS, I AM THE MOST TYPE “A” PERSON
YOU WOULD EVER WANT TO MEET.” SHE SAID, “I LIVE FOR MY WORK. I LOVE MY WORK,”
AND THAT’S THE WAY SHE SAID IT. YOU KNOW,
PAY ATTENTION TO THAT. “I LIVE FOR MY WORK.
I LOVE MY JOB,” SHE SAID. SHE SAID, “NOBODY ON
MY HEALTH CARE TEAM, MY INTENSIVE CARE TEAM,
KNEW THAT ABOUT ME, AND THEY HAD A LOVELY,
TOUCHY-FEELY, GENTLE PLAN FOR MY TREATMENT
AND RECOVERY,” AND SHE SAID,
“IT WAS DRIVING ME NUTS.” SO SHE FINALLY GOT
SOMEONE’S ATTENTION, A THERAPIST’S ATTENTION
WHO WAS LISTENING, AND EXPLAINED IN WRITING
THIS IS NOT WORKING FOR HER. SHE NEEDED AND WANTED
TO GET WELL TO GET BACK TO WORK, AND SHE WANTED THE MOST AGGRESSIVE
TREATMENT PLAN POSSIBLE WITH EVERYBODY PUSHING
AS HARD AS THEY COULD TO GET HER OUT OF THERE. SO THEY DID. THEY LISTENED. THEY REDESIGNED
THE TREATMENT PLAN TO BE THE MOST AGGRESSIVE,
ASSERTIVE. THEY WERE ALL ON THE SAME PAGE. THEY WERE ALL DRIVING WITH HER
GOAL IN MIND, AND IT WORKED. SHE GOT BETTER. SHE ALSO SAID, “LET ME TELL YOU
ANOTHER STORY. THE WOMAN IN THE BED NEXT TO ME
WAS A 75-YEAR OLD INDIAN WOMAN, “AND,” SHE SAID,
“HER FAMILY EVERY DAY, “SOMETIMES MULTIPLE TIMES A DAY, “WOULD BRING IN INDIAN FOOD,
NOT BECAUSE SHE COULD EAT IT– SHE WAS ON A RESPIRATOR–
BUT SO SHE COULD SMELL IT AND SEE IT AND REMEMBER THAT
WHAT SHE LOVED MOST WAS TO COOK WITH
AND FOR HER FAMILY,” AND THEN THE TYPE “A” PART
CAME OUT, AND SHE SAID, “AND THAT WOMAN GOT BETTER
FASTER THAN ME,” BUT THESE ARE THE THINGS. IF WE UNDERSTAND
AND HELP PEOPLE EXPLORE WHAT MATTERS MOST TO THEM
AND LINE UP BEHIND THAT, THAT IS WHAT ALLOWS
THE PATIENT-DRIVEN PART OF THIS NEW MODEL
OF CARE TO WORK. THAT’S THE MAGIC INGREDIENT. THEN OUR PROACTIVE STRATEGIES
CAN TAKE EFFECT. THEN OUR PERSONALIZED APPROACHES
WILL MAKE A DIFFERENCE. SO THAT’S WHAT WE’RE UP TO.

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