Quality of Care

What’s the difference between a 15-year-old volunteer emergency responder and a doctor? Well, lots of things, but here’s one you might not expect: until recently, only the 15-year-old practiced a standard protocol of communicating with other health care providers.

This is big news to me. I was trained as a volunteer ski patroller back in high school, completing both my Outdoor Emergency Care and Wilderness First Responder certifications. In both courses, my instructors emphasized clear communication from day one. There was a strict protocol for each dialogue, and although we were all medical novices, by the end of training we were pros in reciting a SOAP Note: Summary (age, sex, chief complaint, etc), Observations (patient exam, vital signs), Assessment (what you think the problem is), and Plan (what you think should be done about each problem).

If you think we've got problems here in the U.S. developing evidence-based medicine, just think about the challenge in a place like Russia. Health writer and blogger Merrill Goozner just spent two weeks reporting in Russia, and we were fascinated by his piece on the Scientific American website.The problem, he writes, begins in the medical schools, where "young doctors receive almost no instruction on biostatistics, epidemiology and methods of decoding the evidence generated by clinical trials." Russian doctors make about $800 a month, meaning getting access to western medical literature is often out of reach (besides, it's in English). So while neither our health system nor our lawmakers have yet figured out how to stimulate more comparative effectiveness research (and how to get the research acted on), at least we aren't treating pulmonary patients with aerosolized salt dust in "cave-like rooms"—a practice that's been common in Eastern Europe for two centuries, but according to Goozner, never systematically studied.

"Patient-centered medicine" is one of the buzzwords in health these days, so it was refreshing to hear from patients who actually had a voice in finding that center. Four spoke at a panel this spring sponsored by the Institute for Healthcare Improvement. Four patients. Four very different experiences. All had some success in creating a more responsive health care system. And when we at New America talk about reforming health care, we don't just mean insuring people. We want everyone to be covered so they can be part of a system that delivers high-quality, cost-effective, patient-responsive care.

(If you are interested in the difference between "patient-centered health care" which involves how we deliver care that patients need, and "consumer-directed medicine" which is a market-oriented approach to financing health care, read this Healthbeat post. They are not necessarily mutually exclusive, but they aren't synonymous.)

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Maggie Maher, a health blogger we read regularly, has a poignant post today about untreated pain, inappropriately aggressive high-tech care, and the lessons that young medical students (not to mention some older doctors) still must learn about why "good care" and "cure" are not synonymous.

Maher spent some time with Dr. Diane Meier, a geriatrician and national leader in palliative medicine at Mt. Sinai Hospital in New York, and she watched Meier share with medical students some of what she has learned about how to help seriously ill or dying patients. I learned a lot from Meier and her colleagues at the Center to Advance Palliative Care last year when I was doing an extensive reporting project on palliative care and hospice. (Click here, here, and here).