The Transformation of Healthcare
Our approach to health is undergoing a transformation, with profound implications for the role of the patient, the practice and business of medicine, and for many of the efforts we’ve come to think of as patient safety projects. The impulses feeding this transformation come largely from the public—consumers, politicians, government agencies, nonprofit organizations—not so much from providers and traditional medical institutions. This transformation is consistent with a broad-based consumerism movement, driven in part by access to information and technology.
All around, I see signs of this transformation, and I’ve begun writing about it. In my Editor’s Notebook column in the May/June issue of PSQH (my column is available now, with the rest of the issue available shortly by mail and online), I settled on the concept of personal accountability to describe an important element of this transformation as it affects patient safety. Personal accountability amounts to individuals and organizations committing themselves to performing to the best of their abilities, communicating with honesty and respect, and using technology and data effectively and appropriately?all of which are important drivers of patient safety.
Will Smythe, MD, explores this general healthcare transformation in “The Decline and Fall of American Medical Authority,” an essay posted to his blog Will and Reason on May 26. Smythe describes the evolution of healthcare from basic home care in the 19th century, through the development of the science and business of medicine through the 20th century, and recent changes that begin to return responsibility for healthcare back to individuals and patients. Symthe reflects,
When I was a busy surgeon, I would routinely ask post-operative patients on hospital rounds how they were feeling, as I would enter their rooms—some variation of the simple question, “How are you doing today?” Interestingly, one of the more reproducible responses was, “I don’t know… you’re the doctor—tell me.” There are early indications that as a species, our willing and dispassionate dependence on someone else to manage our health and tell us how we are feeling has peaked.
Smythe goes on to describe ways in which individuals are assuming more direct responsibility for their health and becoming more engaged in medical decision making. He finds evidence in stories about patients who have challenged physicians to go beyond assumptions to find a correct diagnosis, members of the Quantified Self movement who routinely collect and analyze data about their own health, and companies that are beginning to make genetic information available to consumers. Smythe comments, “Like it or not, the end of total dependence on the traditional delivery system to tell you what is wrong with you and view you as a passive participant [in] the battles that are waged against your own illnesses has long since passed.”
Patient safety is part of this evolution away from authority and paternalism and toward everyone being accountable as active participants in health. Patient safety, with its emphasis on teamwork, respect, and transparency, can provide important leadership for the transformation.