Re-examining what it means to be great
Elizabeth Newman, McKnight's Senior Editor
Conversations on a trade show floor allow you to find out similar interests in a way that nothing else can.
Who knew, for example, that I would meet someone at the American Health Care Association show in Tampa last month who was a fellow cat rescuer? Or that I'd find fellow Atul Gawande groupies Monday at the LeadingAge convention, i.e. people who had devoured his articles in the New Yorker (such as this must-read) on end-of-life care) and books that include “Complications” and “Better”?
After Gawande presented at the opening general session Monday, I suspect that I'd be able to recruit more people into the Gawande Geek Brigade. While he's not one to engage in verbal pyrotechnics or theatrics, his calm message essentially boiled down to a few main points: Healthcare providers are still puzzling over what it means to be great, and that that most expensive care is not the best care.
He interspersed those points with personal stories, such as counting the number of healthcare professionals who interacted with his mother during her time in a rehab facility following knee replacement. That number? 63. It included 19 different physicians. In the average Medicare patient's last year of life, he or she has 10 physicians, Gawande noted. Independence, not caregiving teamwork, has historically been rewarded.
“We have trained people to be cowboys,” he explained. “But it's pit crews that we need.”
Gawande recapped a story where he followed a hospice nurse as she visited a patient with congestive heart failure.
“My image of hospice was someone on a morphine drip,” he said. When the hospice nurse visited the patient, she arranged to have the nebulizer fixed, among other changes, and Gawande expressed surprise.
“I thought your job was to let nature take its course,” he recalled. The nurse explained that the actual goal is to let the patient “have the best possible day she can have.” That point – so clear to the hospice nurse – is one that gets lost by physicians, family members and healthcare providers, Gawande noted. Instead of the goal being to live forever, the goal needs to be thought out and articulated: What does the patient or resident really want?
“We sacrifice people's time now for time later,” he said. In many cases, “It wasn't about saying to stop treatment. It's having a sense of the goals. Why wait for hospice to have your best possible day now?”
“The problems in people's lives as they age are the problems of life,” he added. Long-term care providers must not only be able to find ways to deliver efficient care: Ultimately, they have to re-examine what it means to be truly great at one's job.
As a keynote speaker Monday, he was an excellent example.