What a great day!
Hundreds of mainly American (I am one of 4 Canadians here) doctors, patients, nurses, health administrators, and other health providers gathered today for the first of three days on the Road to Right Care Conference, put on by the Lown Institute.
Being in a room with so many like-minded individuals is invigorating but also offers hope that together, we can actually do something radical.
Main Themes:
- Patients and their families and advocates must be at the centre of this movement; young health care providers are the future of this and must be engaged early in their training
Health care is not about consuming, being sick; most of what we do in medicine has no impact on health; health care should be about being well, and about people not diseases:
“A good physician treats the disease, the great physician treats the patient who has the disease.” - DR. WILLIAM OSLERSocial determinants of health, especially poverty must be addressed for greatest impact:
"I can cure homelessness. You just house them and it's cured. Completely curable problem." - DR. MITCHELL KATZOur system must be radically transformed; we have many ideas but they boil down to the fact that HIGER QUALITY CARE leads to LOWER COST
Barriers to improvement: financial conflicts of interest, profit-based systems, not listening to what patients really want (eg. independence)
Things that will help us achieve RightCare: team work, communication, destroying the imbalance of power, narratives
Knowing this is what was waiting for us outside, it could have been pretty hard to sit indoors all day... (Harbour of San Diego, view from the Convention Centre steps after my walk last night)
Luckily it was highly engaging and much hope was offered (Bright Spots in #RightCare, highlighting innovative successes)
My actions as a result of today:
- tried to spread the word that this 'movement' is happening around the world
- have learned about some great initiatives and will add them soon to the list of projects advancing this movement or to the hands-on tools section
- added some very 'on the button' quotes to my collection
- added Confessions of a Medical Heretic to the books section and to my own "to read" list
- have started scribbling ideas for my next paper
What was missing?
- Emphasis on relationships between patient and caregiver. The ONLY big mention about meaningful relationships was by a Reverend B. Stanfield during his reflection at the end; the data tell us that strong relationship = better care, and less costly care
- Focus on patient safety. Americans talk A LOT about cost! Cost is important, but were this conference anywhere else in the world, the main focus would be on reducing harms done to patients by too much or too little medicine.
- Acknowledgement of this as a world-wide cultural issue. There was a lot of discussion about insurance companies, ways of paying physicians, etc. as if these financial structure problems all explain the issue; some people seemed to believe that changing the way doctors are paid – abandoning fee-for service payments – would fix everything. But, there is no system of remuneration that incentivizes good care. "Wrong care" is a problem around the world, even in socially progressive and fully public health systems.
I can't wait to see what is in store for us tomorrow!