What I'm Reading (and thinking)

  

Much of the travails in clinical care involves individualizing each experience - simultaneously ensuring people feel heard, that we educate as much as possible and respond to every question, and demonstrate care as much as healthcare. The delivery of that system, of being a person who succeeds and errs and has a personality and our own emotional placement within the order of things, knits within the framework of a person's perception of that experience. Neither of us, patient nor provider, participate in healthcare in a vacuum - we are in a room together, seeing and hearing each other, at times with the same experience and at other times with different ones. 

My partner is currently in business school (to ultimately work in the non-profit sector and allow those organizations to succeed as much as for-profit businesses), and he read me a story about patients of physical therapists not following home exercise routines. The consultant team working with the group found that the patients did not realize the background or training of the physical therapists in the same way they did their physician counterparts, and thus did not follow their guidance. When the PT practice put their degrees, certifications, and awards  on the wall of the PT rooms, home exercise routines went up 34% and have never decreased. A simple change in space, or a simple communication technique, ultimately changed patient outcomes. Somehow, neither group had effectively communicated this issue before, and what a quick fix to lead to life changing differences.

What is it about the spaces we create, such as joined midwifery practices and feminist sex shops, or the spaces we hold, such as for the dying and their families, that either makes or breaks experiences for those who provide healthcare and those who seek it? How can we better consider our language and counseling and consent, to ensure that we have at least communicated the work that we are doing and the place of care from which it stems, to ensure people know that we are treating both them and their disease and create a foundation of empowerment rather than fear? And, importantly, recognize that the 'but' at the end of our belief systems and our presentation does not make a convincing argument in any sense of the word?

The articles I've been reading through this week are really a call to attention for myself personally, about the spaces I create or the space in which I practice, patient understanding and satisfaction (or, in some cases, dissatisfaction even with appropriate and evidence-based care provision), and allowance of the space between my own experience and the experiences of those I serve. 

I hope you are all well. This is the second of these posts, where I allow myself to really sit with something I've read and process it openly, and I'm enjoying it. All comments welcomed. 

Warmly,

Stephanie

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Heart of the Matter: Treating The Disease Instead Of The Person - Leana Wen, NPR

"...The objective measures that health care workers focus on are necessary, but they're not enough by themselves. Every provider in this man's case had good intentions and was working hard to respond to the medical emergency. But in their rush to open the blocked heart artery, they treated him as a disease to be cured, not a person to be cared for.

Would it have alleviated the patient's anxiety for the doctors and nurses to introduce themselves, and to ask if he wanted his wife by his side? Would it have helped to assure him that all the activity was happening around him because everyone was trying to take care of him?

I think those simple courtesies would have made a difference.

These instructions aren't on typical checklists for treatment of heart attack, yet they are part of caring for people as human beings. In modern medicine, we are fortunate to have incredible high-tech options available, but we must not forget the low-tech approaches that can improve communication and quality of care..."

How Fear Rules Maternal Healthcare - Jeanne Faulkner, Every Mother Counts

"...Rankin recommends a radical transformation in how we approach all types of healthcare. She recommends focusing on factors we know contribute to real health like nutrition, exercise, a sense of purpose, community, love and happiness and save the medical interventions for when they’re really needed. Rankin says, “This won’t be easy and in fact it requires a complete paradigm shift, but I believe that’s what’s it will take to turn health and healthcare around.”

For healthy women who are pregnant now, you might lower your risks for unnecessary medical intervention by accessing prenatal care from midwives who view pregnancy as a more normal physical event than obstetricians often do..."

Yes, your but looks big in that hypocrisy - lizzi, Whole Woman

"...*The doctor has your best interests at heart 

Maybe. Maybe not. But we are back to that pesky right to make an informed decision. Yep – even if your doctor thinks something else would be best for you they don’t have the legal backing to make that call. 

And even if they do genuinely want what’s best for you – who are they to decide what’s best for YOU? They aren’t you. A doctor who want’s what is truly best for you will ask: What do you feel is best for you? And will then step up to help you make that happen. 

What it means to 'hold space' for people, plus eight tips on how to do it well - Heather Plett

"...What does it mean to hold space for someone else? It means that we are willing to walk alongside another person in whatever journey they’re on without judging them, making them feel inadequate, trying to fix them, or trying to impact the outcome. When we hold space for other people, we open our hearts, offer unconditional support, and let go of judgement and control.

Sometimes we find ourselves holding space for people while they hold space for others. In our situation, for example, Ann was holding space for us while we held space for Mom. Though I know nothing about her support system, I suspect that there are others holding space for Ann as she does this challenging and meaningful work. It’s virtually impossible to be a strong space holder unless we have others who will hold space for us. Even the strongest leaders, coaches, nurses, etc., need to know that there are some people with whom they can be vulnerable and weak without fear of being judged..."

New space on Cherokee Street will be part midwifery clinic, part feminist sex shop - Durrie Bouscaren, St. Louis Public Radio

"...“With those who identify as female or are identified as female, you have this dichotomy between those who are allowed to be sexual and who are allowed to bear children,” Rosen said. “When one person decides to do one of those things you have one or the other.”..."

The Problem With Satisfied Patients - Alexandra Robbins, The Atlantic 

"...Joshua Fenton, a University of California, Davis, professor who conducted the study, said these results could reflect that doctors who are reimbursed according to patient satisfaction scores may be less inclined to talk patients out of treatments they request or to raise concerns about smoking, substance abuse, or mental-health issues. By attempting to satisfy patients, healthcare providers unintentionally might not be looking out for their best interests. New York Times columnist Theresa Brown observed, “Focusing on what patients want—a certain test, a specific drug—may mean they get less of what they actually need. In other words, evaluating hospital care in terms of its ability to offer positive experiences could easily put pressure on the system to do things it can’t, at the expense of what it should.”

As a Missouri clinical instructor told me, “Patients can be very satisfied and dead an hour later. Sometimes hearing bad news is not going to result in a satisfied patient, yet the patient could be a well-informed, prepared patient.”..."