Healthcare That Fits

As part of my research focus, I spend a lot of time thinking about healthcare and what its purpose is.  It seems to me that healthcare (and therefore health itself) is only useful insofar as it generates happiness.  If being healthy (or making someone else "healthy") doesn't translate into any measurable form of improvement in the experience of life, then it doesn't really accomplish anything meaningful.  Now, there are certainly situations where "enduring" good health or its necessary treatments or lifestyle changes may not bring immediate enjoyment...but, often these sorts of interventions permit the sorts of results patients want in the future--the ability to play with your grandkids, the opportunity to walk your daughter down the aisle, etc.  Distinguishing these cases and indications is essential, and carefully weighing the evidence of what is and is not likely to have desired effects is central to the practice of high-quality care.  Determining what fits who is one of the biggest challenges in healthcare, and it requires intimate understanding of what it is that makes our patients tick.

Americans spend more money on healthcare than anyone else in the world, but we aren't the happiest people in the world (not even by a long shot).  Then again, we aren't the healthiest either.  Somewhere something is getting lost in translation.  Medicine doesn't fit people like it's supposed to.  I think part of this stems from the fact that healthcare is slowly losing sight of its purpose.

According to the Bureau of Labor and Statistics, healthcare is a "service-providing" industry.  Sometimes it seems more "goods-producing."  We do not often think about health services as a resource designed to meet our needs and life desires.  Who thinks of their physician in the same way they think about their auto mechanic or their hair stylist?  And yet, healthcare, like these other service industries, exists to meet the needs of its consumers (i.e. the patients).  But I think anyone would balk at the suggestion that their mechanic could impose whatever repairs he sees fit or that their hair stylist could simply choose a haircut that matches his or her taste without even considering the preferences of the one forced to wear it!

Minimally disruptive medicine (minimallydisruptivemedicine.org) is one part of the solution to this problem, as it strives to remove unnecessary and useless care that only adds to patient burden.  It also seeks to maximize patient capacity to be well, such that simply being a patient is not the end in itself, but is a means to an end that brings value to a patient's life.

I have become increasingly familiar with the role of health or wellness coaches (and, more broadly, life coaches) can play in helping to achieve these goals.  In many cases, the sort of holistic evaluation and approach to well-being that coaching can provide is of far more value than any diagnostic test or intervention traditional medicine can offer.

Case in point.  My grandpa has had a number of health issues develop over the last decade or so.  His prescriptions and various medical appointments and evaluations help to bring some degree of health benefit, but they do not bring happiness or any value in regards to his quality of life.  Thanks to the accurate perception of concerned family members, however, he was given a couple dogs that have absolutely changed his outlook on life.  They've brought meaning, joy, and purpose to his life in a way that traditional medicine never could.  Identifying the things that bring meaning to patients' lives is essential to achieving the outcomes we desire.  I am excited to think about this more seriously and generate more formal approaches to this type of patient assessment.  I am interested in people's thoughts.