In the first week of December I attended a conference in Boston that was organized by the Lown Institute. It was their second conference, and somewhat unusual in that it was by invitation only. The title of the conference was Avoidable Care to Right Care and followed on from their 2012 conference, Avoiding Avoidable Care. The 300 attendees from all over the globe included medical providers and students, journalists and patient activists. It was inspiring to be with so many people who are passionate about changing a system that too often hurts those it is supposed to help.
I started to write about the conference but got bogged down in the details because I wanted to describe all the people I met with their variety of backgrounds and experiences. There were many stories amongst the speakers, too. All this variety contributed to the complexity of the problem we were discussing – how to get the right medical care for people, not just here in the US, but in other developed countries as well. After the conference, when people asked me about it, I had trouble describing what it was about. I would have liked a 3-4 word phrase to describe it and a simple way to describe the problems and solutions, but I don’t know if there is one. I do believe, as I did when I came away from the Preventing Overdiagnosis conference in Dartmouth, that because the problems are created by us all – medical treatment providers and patients – we can all contribute to changing how health care is practiced.
The Lown Institute is founded by Dr. Bernard Lown, a world-renowned cardiologist who invented the cardiac defibrillator. I’ve been reading his book, The Lost Art of Healing, and like Michael Millenson’s book, Demanding Medical Evidence: Doctors and Accountability in the Information Age that I wrote about before I attended the conference, it was written in the late 1990’s. Sadly, both books are still relevant and make the point that health care as we know it needs to change. Dr. Lown’s motto, “Do as much as possible for the patient, and as little as possible to the patient” was repeated many times throughout the conference, as it struck a chord with us all.
Speakers at the conference covered many topics. We heard from people who experienced the harms of overtreatment during childbirth, through cancer treatment and when dying. We learned that although we believe it to be common knowledge that doctors often order unnecessary tests and treatments because they are concerned that they may be sued for medical malpractice, there are only a small percentage of cases that go to court with the majority of cases resulting in favor of the defendant. There was good news, as we heard about programs already in place that educate doctors and patients about shared decision making, and others that show how “slow medicine” and doctors spending more time talking with patients, can reduce hospitalizations and emergency room visits. Several speakers discussed how there could be a more realistic approach to end of life care to allow people to die with dignity.
As part of the topic of “Reintegration of Health and Health Care in the 21st Century” we heard about designing healthy communities to include making healthy whole food more accessible, and universal design that can enable us to stay in our homes longer. We were asked to imagine what health care would be like in 25 years. Some points that were made during a discussion:
- Change medicine so that it is no longer treated as a commodity when it should be a human right
- Medical care and health care are not the same
- Encourage fewer conflicts of interest and make better use of Information Technology
- Reduce the complexity of health care and insurance
- Government sponsored quality improvement organizations
- Move medical care out of the office and into the home in order to understand how patients live and deal with their medical conditions, doctor instructions, etc.
- We tax alcohol and tobacco because they can harm us, so why not tax firearms, carbon and fructose?
A highlight of the conference was when Dr. Lown spoke to us about restoring humanism to medicine – what he referred to as the New Renaissance. He talked about the lost art of listening, how patients are ignored as human beings, and that the patient’s rightful place is at the center of their healing.
When asked about the highlights of the conference, many people referred to China, Maine – yes, there’s a town in Maine called China – and we heard from the Town Manager on how the increasing costs of health insurance for the town’s employees affect this small town. In order to pay for health insurance, cuts have been made to public services like the town’s fire department and the maintenance of roads, and they’re unable to fund a public library. I think this perspective showing indirect costs of health care was new to many of us and made quite an impact on the audience.
A mock town hall meeting was held and moderated by two experienced organizers. It was one example of how to engage the public in the discussion, and we discussed this concept and others in a workshop held on the final day of the conference. In the workshop, as with the conference, the variety of backgrounds, experiences, and paths that brought people there were notable but we had a common mission to educate the public and enlist their help to assure that we all receive “right care”.
Patients Are People, Too!
When we consider medical care, we often look to studies and data to determine what is most effective, however, as one speaker noted in their closing remarks, human suffering is immeasurable. Telling our stories will show the “person” side of the patient and bring home the message to other patients that they are not alone in their experiences of medical care that causes harm. Telling our stories can also make the medical professionals aware of how their actions affect people. Stories are more memorable than statistics, so let’s tell our stories and make things right.