Health­care needs an em­pa­thetic work­force fo­cused on the spec­trum of ‘com­plex ill­ness’

Modern Healthcare - - Comment - By Dr. Stephen Klasko Dr. Stephen K. Klasko is CEO of Jef­fer­son Health and pres­i­dent of Thomas Jef­fer­son Univer­sity in Philadel­phia.

Once upon a time, TV med­i­cal dra­mas were about heroic doc­tors sav­ing pa­tients. Think Ge­orge Clooney in ER, res­cu­ing a boy trapped in a flood­ing storm drain, or even Mar­cus Welby lis­ten­ing to a sui­ci­dal pa­tient and pro­vid­ing an­swers and so­lace.

But the lat­est en­try in this genre ac­knowl­edges what all of us now un­der­stand: It’s not just pa­tients who need sav­ing, but the health­care sys­tem it­self.

This is the premise of NBC’s New Am­s­ter­dam. The show fea­tures a doc­tor named Max Good­win, who has just been hired as med­i­cal di­rec­tor for a con­ven­tional New York pub­lic hospi­tal. In short order, he elim­i­nates the wait­ing room, in­tro­duces healthy food for pa­tients and fires an en­tire sur­gi­cal depart­ment for “plac­ing billing above care.” Good­win is a dis­rup­tor, aim­ing to shake up a hide­bound sys­tem that puts process over peo­ple.

The fact that a show like this ex­ists speaks to the depth of our health­care cri­sis. A ma­jor net­work, us­ing so­phis­ti­cated mar­ket re­search, has de­ter­mined that what will sell in 2018 is a de­pic­tion of the bro­ken, back­ward-look­ing sys­tem that’s dan­ger­ously dis­con­nected from the needs of the very peo­ple it ex­ists to serve.

Be­fore we get de­fen­sive about that de­pic­tion, it’s worth re­mem­ber­ing that many pa­tients see ex­actly that—a sys­tem that re­mains frag­mented, opaque and in­equitable.

New Am­s­ter­dam also de­picts clin­i­cians lack­ing em­pa­thy. To me, we need to re-ex­am­ine our roles in the age of aug­mented in­tel­li­gence. Em­pa­thy is not sym­pa­thy—it’s a teach­able, mea­sur­able cog­ni­tive skill that al­lows a physi­cian to an­swer the ques­tion, “What does this mean, doc­tor?” That’s the core ques­tion for physi­cians in the age of AI—we must be the hu­mans in the room, even if that room is vir­tual.

Part of the prob­lem is that we don’t have a work­force pre­pared for “com­plex ill­ness”—that crit­i­cal com­bi­na­tion of phys­i­cal health, men­tal health and so­cial health. I’m im­pressed with the med­i­cal schools that have built stu­dent in­ter­pro­fes­sional teams that fo­cus on teach­ing doc­tors to be more em­pa­thetic. At Thomas Jef­fer­son Univer­sity’s Sid­ney Kim­mel Med­i­cal Col­lege, we cre­ated the Jef­fer­son Scale of Em­pa­thy, an in­ter­na­tion­ally known and val­i­dated in­stru­ment for mea­sur­ing em­pa­thy in the con­text of ed­u­cat­ing health pro­fes­sion­als.

Thomas Jef­fer­son Univer­sity is also one of only four na­tional “hotspot­ting” pro­grams in the U.S., which pairs high uti­liz­ers of our emer­gency depart­ment with stu­dent co­horts who work di­rectly with pa­tients to in­ter­vene, ed­u­cate, lis­ten and guide. Our data anal­y­sis shows that our “hotspot­ters” have re­duced these pa­tient’s ED vis­its by 50% and out­pa­tient vis­its by 40% within the year of our pi­lot project, 2017-18. Equally im­por­tant, our stu­dent par­tic­i­pants showed mea­sur­able in­creases in self ef­fi­cacy and em­pa­thy scores.

So­lu­tions re­quire a rad­i­cal re­think­ing of the way we work. For starters, we should work to­ward open plat­forms that al­low pa­tients and health pro­fes­sion­als seam­less ac­cess to health records, ther­apy pro­files, and most im­por­tantly, a dash­board for health. We over­es­ti­mate tech­nol­ogy, like EHRs, in the short run, but un­der­es­ti­mate its im­pact in the long run. As com­put­ers be­come the pa­tient concierge, and repet­i­tive work­loads shift to aug­mented in­tel­li­gence, it’s up to us to de­sign a sys­tem that is hu­man, mean­ing­ful and con­nected to all our pa­tients.

Quite sim­ply, we need what I call “health­care with no ad­dress.” We need help where we are, when we need it, to build our own best lives. We need a nar­ra­tive of health that spans the phys­i­cal, men­tal and so­cial.

Doc­tors—and health­care teams— have an im­por­tant role to play in the com­ing trans­for­ma­tion. But so do pa­tients, politi­cians, em­ploy­ers, ed­u­ca­tors and tech com­pa­nies. If we work to­gether to in­tro­duce bet­ter tech­nol­ogy and ap­ply pres­sure to fix a bro­ken sys­tem, we just might cre­ate a world in which doc­tors can en­joy be­ing even more heroic than the ones we see on TV. ●

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