Recently I was privileged again to be on the faculty for the Summer Institute of the George Washington Institute for Spirituality and Health in Washington, DC which draws participants from several health care disciplines, including medicine, chaplaincy and nursing.
One afternoon, we break up into interdisciplinary teams and interview patient actors as if we were a palliative care consultation team. For those who have not experienced patient actors in this context, they are incredibly professional and convincing. The response of even seasoned health care professionals who interact with them is generally that it is impossible to tell that they are not truly the patient they are portraying.
This exercise is difficult for the “team” on a number of levels. First, generally we have never even met each other before let alone developed a working relationship. Second, very few of us are used to interviewing patients as a team. That is, in this model we all interview the patient at once as opposed to the normal practice in which the patient is interviewed by the doctor and next the patient is interviewed by the chaplain and so on. Then after the patient is shuffled from one team member to another, the whole team comes together and discusses the case before the patient is brought into the discussion. Sound familiar?
The interesting learning for me from this exercise was that this team interviewing process is new and difficult for the team members and exposes each of us in a way that we are not used to. We have to be publicly accountable to and trusting of our fellow team members in a new way. We have to listen to each other as well as the patient. The process feels messy. We can’t just follow our own particular mental or physical check sheets on what we have to cover.
However, the feedback of the patient actors was that this process felt very supportive and met their needs. Why? In part it was because they felt listened to and cared about which is instructive in itself. However, also in part because they were treated as whole persons. They didn’t have to deal with their physical selves in one interview, their social selves in another and their spiritual selves in yet another. Further they also didn’t have to deal with the different parts of their physical selves in different interviews. And the plan that the team recommended to them reflected this whole person care.
One of the patient actors characterized this as “one stop health care.”
So if this model is so appreciated by and useful to patients, why don’t we who are supposed to be patient-centered do all of health care this way? I could list the many reasons that we as health care providers could come up with, but all of us know them. Most of these reasons have to do with how inconvenient this would be for each of us as providers simply pointing up again that our system is still mostly built around the needs and convenience of the staff rather than the patients.
So what would it take to change the process?
I think we would have to commit to asking at every step of the way, “Are we doing it this way because it is best for the patient or because it is best/most convenient for us as providers?” I think we will find that today most often the answer is the latter not the former.
If we flipped it, we would have to hold each other to the premise that we are about the patient and not about us. My guess is that, if we could make this kind of change, not only patient satisfaction would improve, but health care outcomes would also be better, certainly communication among the team would improve, and costs of all kinds would decrease.