This is a special occasion for me, a guest post by Dr. Louise Glaser.
Louise is a pediatrician in the Kaiser Permanente system, where among other things she’s Chief of Leadership and Communication Development in the Sacramento area. I met her a year ago at the annual Conference for Global Transformation (CGT), and again this May.
This year she was one of the presenters. Using her training in transforming relationships and conversations, she’s been developing courses for staff at her 1,000-provider medical center, so she has some serious street-level experience in what works.
From the pre-publication results I heard her present at CGT, it seems clear that both providers and patients are benefitting greatly from the new kind of listening she teaches. Her results today have a lot to do with both doctors and patients speaking up, and both doctors and patients listening. Her message is empowering and participatory. — Dave
I am a pediatrician at Kaiser Permanente in Northern California. I have some ideas about what it will take to provide high quality affordable health care that has people have the experience of being heard and cared for, and has doctors remember why they chose a life’s path of medicine.
What if the world were a place in which all people were empowered in their health care? The doctor –patient relationship provided listening and healing for all? I believe this is possible. Here is some of what I think it will take for us to get there.
I have noticed that what we have now, in general, is not that. We have a health care system in which the common leading conversations are “there’s something wrong that needs to be fixed,” “I know and you don’t,” “I can and you cannot,” “How come you aren’t doing what I told you” (often thought and not spoken), “Why aren’t you listening to me,” “You’re supposed to fix me,” “I don’t trust him/her. Why should I do what they say?” etc. Another commonly heard or thought sentence is “It’s not my job/ responsibility.”
What if the conversations in health care were about healing, about health care providers supporting people in their health and well-being? Providers are so well trained in science and medicine. Experts. But mostly we don’t get much training in the art of communicating and being with other human beings. Patients are experts in themselves, in their lives, in what does not seem right and how that is impacting them right now. There are many times when there’s not really anything “wrong,” rather a matter of a desire to increase one’s health to a higher mark than it is right now.
Is it possible to bring together the science and medicine expert with the patient person expert and fill in the gaps of what each party may not know? Is it possible to empower and nurture a person in their health and well-being, not simply fix them?
Can a person participate in their own care, bring their own requests, desires, information, brand new concerns, old belabored ones, new thoughts, etc to the table for consideration. Can these contributions be valued along with the expert science and medicine that has been painstakingly learned, gathered from data and research to provide the needed information to incorporate signs and symptoms into a diagnosis and create a plan for care?
I say yes and it is critical for all of us. Here’s why…
You are highly skilled in your field or fields. The patient is bringing you the gift of their story for you to care for. Use your expertise to its full glory and be curious. Be in partnership with your patients. Inside your listening some of what concerns your patients will disappear simply in the opportunity for them to tell you their story. Consider listening to what it must be like over there. Could you be willing to not know the answer and let your patient fill in the gaps? They will tell you stories that will alter your life and theirs.
Say what you need and want when you go to the doctor. Speak from being empowered and nurtured. Consider that you are an expert in you. You may need the expertise of your provider. Together you will likely find exactly what you need to be healthy and well. What you don’t know they may, and what they don’t know you may. The combination can be magical and miraculous. An opportunity to tell your story, short or long, is sometimes in and of itself healing.
For all of us and ideas of how to get there:
By having a regular doctor with whom you have a relationship I believe people will be more likely to communicate what they need and to communicate it earlier. If there is someone they trust to listen they may follow health recommendations. If it is unclear what the next step is the patient and the provider could work it out together. Some issues may be resolved simply in the speaking of them out loud. Ultimately this could lead to decreased medications, decreased overall visits, decreased visits to the Emergency Department, decreased and/or shorter hospital stays as things are handled earlier. We could also see an increased likelihood to take medications as recommended.
Ultimately people would become healthier, fully involved in their own care.
- Everyone would have a regular doctor with whom they are familiar.
- Electronic medical records everywhere to which the patient has access, at least to parts of it.
- Communication training in medical centers and medical schools and with ongoing practice.
Thank you for reading,
Louise Glaser, MD