{"id":10063,"date":"2011-08-23T12:01:52","date_gmt":"2011-08-23T16:01:52","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=10063"},"modified":"2011-08-23T23:15:43","modified_gmt":"2011-08-24T03:15:43","slug":"who-can-fix-health-care-al-mulleys-talk-at-tedx-dartmouth","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2011\/08\/who-can-fix-health-care-al-mulleys-talk-at-tedx-dartmouth.html","title":{"rendered":"“Who Can Fix Health Care?” Al Mulley’s talk at TEDx Dartmouth"},"content":{"rendered":"

Stop what you’re doing, as soon as possible, and spend 20 minutes watching this. It’s the most powerful short talk I’ve ever seen about health care.<\/p>\n

Our e-patient white paper is titled “e-Patients: How they can help heal healthcare.”\u00a0In this talk from March’s TEDx Dartmouth, Al Mulley, MD, MPP doesn’t use the word e-patient, but he asks directly: who can fix health care? “Doctors and nurses can’t; policymakers can’t; even presidents can’t,” he says. Guess who that leaves.<\/p>\n

<\/object><\/p>\n

(Email subscribers, if you can’t see the video, click to come online.)<\/em><\/p>\n

<\/em>TEDx events<\/a> are smaller, independently organized events in the TED<\/a> family. Dartmouth produced one last March, and one speaker was Al Mulley, Director of the new Dartmouth Center for Health Care Delivery Science<\/a>. Yes, the science of delivering healthcare – think evidence-based medicine, expressed in what their site calls “an aggressive collaboration” across all of Dartmouth’s schools and the Dartmouth-Hitchcock hospital system.<\/p>\n

Mulley was a founder of the Foundation for Informed Medical Decision Making<\/a> (FIMDM), about which we’ve written here several times<\/a>. FIMDM is in turn a prime sponsor of Gary Schwitzer and team’s Health News Review, about which we’ve written much more<\/a>. Both are highly participatory – they’re all about patients being better informed and empowered.<\/p>\n

Al has a way of taking an immense amount of information and conveying it quickly and clearly. People have spoken for hours and not delivered this message so well.<\/p>\n

Decision making in uncertainty – “the fog of healthcare”:<\/strong><\/p>\n

We’ve often written<\/a> about SDM (shared decision making). At 9:45 Mulley shows a “Stacey Diagram,” adapted from UK change management guru Ralph Stacey. He’s just reviewed how there are Here’s how he describes it:<\/p>\n

\"\"<\/a>\"\"<\/a><– Illustration at Left: “When uncertainty is low, about getting B if you do A, and disagreement <\/em>is low about how good or bad B is, decision making and execution can be simple.” [Bottom left corner]<\/p>\n

“When uncertainty is high, and disagreement is high, decision making and execution can be chaotic.”<\/p>\n

Then the slide at right: “Most<\/em> of life, and certainly most of healthcare, is in this zone of complexity.”\u00a0And here’s the crux of SDM done right:<\/strong> “It’s the profession’s job to reduce the uncertainty as much as possible …\u00a0It’s not <\/em>the profession’s job to try and get people to agree…to get two men to agree about the tradeoff between urinary function and sexual function … two women to agree about how bad it is to live without a breast, how bad it is to live with the prospect of a recurrence.”<\/p>\n

He cites the evidence that when patients are fully informed about risks and benefits, they tend to choose less <\/em>treatment.<\/p>\n

The climax of the reasoning – “Who can fix health care?” – is in the slide around 16:00, which builds to this conclusion:<\/p>\n

Patients must shape the capacity of the health care system by revealing their preferences.<\/p><\/blockquote>\n

There you have it: patient centered care, customer-centered thinking, whatever you want to call it. If we don’t educate ourselves – if we don’t ask doctors for all the pros and cons – the system will evolve in the direction its investors like: more sales, aka higher costs. And wait til you see the ultimate impact, in his closing anecdote.<\/p>\n

This TED talk gets my personal “standing O” for its clarity. Plus, it shows that participatory medicine is essential <\/em>to fixing healthcare. The definition from our society’s website<\/a>:<\/p>\n

Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.<\/em><\/p><\/blockquote>\n

If we continue to expect the industry and Washington to fix healthcare, as we’ve been doing for decades, the outcome is unlikely to change. It’s time for patients to step up and ask: “Is this what’s right for my child? Is this what’s right for my parent? Is this what’s right for me?”<\/p>\n

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