For some years I have been following Dr. Brian Goldman, a veteran ER physician and one of Canada’s most trusted medical broadcasters. His CBC radio show “White Coat, Black Art” tackles tough issues, makes sense of “bafflegab” and highlights important new innovations. His book “The Secret Language of Doctors” is an illuminating view inside of the medical system and a great read.
I went to his Vancouver Institute lecture in Vancouver in January entitled: “Disrupt Me + Engage You: The Health Care Revolution”. I couldn’t wait to hear what he had to say about system change in the health field and I was not disappointed. As you may recall from previous posts I think justice reform has a lot to learn from innovation efforts in other disciplines.
He began by describing the healthcare world’s current focus on “patient and family-centred care” i.e. putting patients at the centre. While this has been the mantra in the field for over a decade progress on the front lines has been mixed. He referred to his participation at Kingston General Hospital in a focus group of “patient experience advisors” (former patients or family members who serve as volunteers) who described how patients are afraid to speak up because they are worried that their care would be compromised, how they felt demeaned and how they had no one to advocate for them within the system.
He then described how care professionals use a secret language to prevent others from understanding the real meaning. The most common example is the term “frequent flyers” – those who visit the hospital frequently. Many have chronic diseases and need genuine care. He said that 75% of health care expenditures deal with this group of people. He noted that while in the business world they would be very valued customers, in the publicly funded health system they are not valued.
Other examples include “silver tsunami” (seniors are the fastest growing segment of society), “gomer” (can mean many things including “get out of my emergency room”), “dyscopia” (a made up word to mean inability to cope), and “failure to die” (someone who lingers near death).
To Dr. Goldman all of these stories reveal a fundamental lack of empathy in the health system – an “empathy gap”. He defines empathy as “the ability to use imagination to put yourself in another person’s place and act accordingly”. While he says that human beings are hard-wired to be empathetic training, stress and technology conspire to steal it away. The empathy gap hurts the care professional as much as it hurts the patient and he believes it is the new frontier for health care improvement.
What is contributing to the empathy gap in the health system? Dr. Goldman suggested a number of factors including:
- Medical culture undervalues soft skills
- Care professionals are not selected for empathy
- Training: care professionals are trained for acute treatment (broken bones, appendicitis etc.). They do not receive much training for chronic disease or mental health/addiction issues.
- Fear of failure: “Frequent flyers” create anxiety because their ailments cannot be treated or cured. Care professionals feel the futility of trying to help these people and they may feel that they have “failed”
- Care professionals don’t want to be sued
- It is easier to invent slang than to fix the root causes of these problems
- Technology: increased technology presents a double-edged sword. It increases efficiency but distracts doctors from paying attention to their patients in a real way
- Specialization and fragmented care: the current system allows each care professional to do their job without anyone taking responsibility to “care” about the patient
- Rigid rules in fee schedules: caring takes time.
Many of these correlate closely with justice system issues.
Dr. Goldman recognizes the challenges but sees empathy-building as a real opportunity for positive change. His next book will be on the subject of empathy in healthcare (watch for it!). You can watch a similar presentation on YouTube. His fascinating presentation went on to detail some of the innovations he has already uncovered that give hope for a better future including:
- Locating services closer to “medical hotspots”
- Nurse practitioners
- Physician assistants
- Allowing paramedics to treat older patients on the spot instead of just transporting them to hospitals
- Live well health coaches
- Patient engagement: patient experience advisors serving on hospital committees (like at Kingston General)
- Emergency room waiting time apps
- Online apps rating care professionals
- Virtual clinics using teleconferencing tools
- Moving the investment from bricks and mortar and acute care to front end primary care
There are many lessons we can learn from other contexts that are also struggling with system change. But perhaps we should first stop and seriously consider the issue of empathy. Without that how can we really put the justice system user at the centre?