In some private remarks after his keynote lecture for the Wellbeing Lecture Series at the Minneapolis Foundation’s Centennial Futurist Conference, Atul Gawande made a remarkably simple yet very telling statement: “My dad,” he noted, “was able to die as a person, not a patient. And that was the gift.”
Dr. Gawande is a surgeon who comes from a family of doctors and is a best-selling author and writer. He was sharing his perspective after a talk on the Future of Health Care.
Think about his comment again: ‘person, not a patient.’
What do you think he meant? What do you see as the difference between being seen as a person versus a patient?
Our goal as senior and health care providers should always be to help people have a human experience, not a patient experience. But it doesn’t happen that way. And here is one of the foremost voices in the medical field today drawing a line in the sand to reframe the conversation on those two words – patient vs. person.
The Patient Experience?
As much as we talk about patient-centered care, the patient experience is still one that happens to you, not with you. Dr. Gawande provides example after example in his writing as well as his lectures that illustrate this reality. He shared one story of a woman with Alzheimer’s who was ‘written up’ because she was hoarding cookies and was at risk of choking. We focus on health, safety and minimizing risk which take away people’s choices and ability to live a life that is meaningful to them.
He noted that every assisted living community wants to tell you how safe your loved one will be. But what about how much she can do?
As health and senior care providers, he continued, we encourage people to have procedures or treatments of little or no value, without questioning whether this person should have any procedure at all. “What do we do,” he asks, “when we cannot fix? What is the outcome for the person whose life is in decline?”
He shared the insights gleaned from one nursing home administrator who said, “safety is what we want for those we love, but it’s autonomy we want for ourselves.” Yet we don’t ask about autonomy for the people we serve.
The Person Experience
Dr. Gawande related his own father’s story, which started off initially as a patient experience but then became a person experience after he had some crucial conversations on what was important to him. It became clear that there is a marked difference when someone is treated as a person rather than a patient.
The person experience starts with asking four key questions to better understand what is important to them and how they see the situation. Then the key is listening to the answers. What Dr. Gawande says he started to learn as he delved into the experiences people have at end of life, is that “wellbeing is possible even under the most severe constraints and health conditions.”
As Dr. Gawande discovered, “people have priorities in life besides living longer. They care about some things bigger than themselves, and want to know that we’ll respect them and help them achieve those.”
His dad, who is also a surgeon, wanted to continue being a doctor for as long as he could. And when that became impossible, he wanted to be able to continue to come to the family table for dinner as he was very social. By asking those questions, listening, and respecting the answers, Dr. Gawande was able to change his father from a patient to a person.
But we don’t have to wait for end of life to pose these questions. At Lifesprk, we start every client’s experience with what we call a ‘discovery,’ not an assessment. We sit side by side with them to learn what is most important to them, and then help them build a path toward that goal, helping them manage everything that may get in their way across the whole spectrum of their life (what we call the seven elements of wellbeing), not just their physical health.
As health providers, we have the opportunity to change the experience. When we consider what we want for ourselves and our own loved ones, we can make the changes that shift the experience from one where people are seen as patients to one where they are treated as persons.
It can start as simply as the words we use – patient or person? Which would you choose for yourself?
At Lifesprk, we also believe that dramatic change will not come from the government. It will come in small steps from the fringes – from those bold and brave enough to stop, examine current practice, ask, listen, and make the small changes that will become huge advances.
Try it today – shift your thinking: What can you do to help someone live as a person versus recuperate as a patient?