Recently, I attended the 50th Annual Meeting of the American Society of Clinical Oncology in Chicago. This year, several sessions addressed the important question of "value" in cancer care, with an emphasis on maintaining or improving quality of care while reducing the cost of care.
The new science of "health" care that has emerged in the 21st century is creating the opportunity to be successful in preventing and treating chronic diseases. In a successful therapeutic relationship, practitioner and patient work in partnership to create health rather than treat disease.
In providers' hurriedness, the small kindnesses are falling away: a smile, a handshake, a few warm words, making connection. As care drops out of health care we are paying for it; we are sowing greater dis-ease.
Health care isn't that different from other consumer industries except that we not only need our consumers to return to our establishment, but we also need to be increasingly more integrated into their lives and we are increasingly more responsible for their health outcomes.
Doctors need tools that help them give patients personalized, specific, actionable advice and the resources to refer patients from the point of care. A doctor's personal recommendation in the visit can be supported by technology and other members of the medical team between visits.
Tests are increasingly common, visits are increasingly short, and doctors now commonly forego thorough physical examination. Put bluntly, in the exam room we are already doing less talking and touching, and more testing.
When I started my training in psychiatry 45 years ago, the prevailing model for understanding mental disorders was broadly bio/psycho/social in the grand tradition of Pinel. When psychiatry is practiced well, it integrates insights from all the different ways of understanding human nature.
Physicians need to lose the paternal attitude, embrace the new doctor/patient paradigm and gain some new partners who can help us prevent disease, manage big health global concerns (heart disease, cancer, hypertension) and shape a healthier world.
Going into surgery soon? Make sure you know about the "five little pearls" -- bits of practical wisdom that won't be in that fancy color pamphlet that the surgeon gives you or the packet of loose papers that the nurse shoves into your hands as you're hurried out the door after surgery.
The difficulty accepting uncertainty is just as strong today as it ever has been. It leads now to excessive testing, quack treatments, and blaming the patient. We need to expand our frontiers of knowledge, but also to recognize our limitations and do the best we can within them.
We crave real portrayals of people like ourselves: people who can be confused, get angry, celebrate joyous moments and sometimes feel rejected and unloved. James Gandolfini made Tony Soprano, the Jersey mob boss, one of us.