Monday, December 30, 2013

Humanism and Money in Medicine

“Chia buo᷈n” – Vietnamese phrase meaning “share in the sorrow”

If your time is limited, don’t read this blog post. Instead, turn directly to the second-place-winning essay in the Humanism in Medicine contest; this essay was written by David B. Duong, a third-year medical student.  In this essay, Dr. Duong – and I refer to him as “Doctor,” as this essay shows me that he already has the knowledge of the art of medicine that confers upon him that title – writes about his experience acting as the translator for a Vietnamese patient with end-stage colon cancer.  He takes us through the experience of being at the patient’s and the family’s side, as they go through the confusion and the required decision-making when the 83-year-old patriarch is in the hospital with a bowel perforation – a hole in the large intestines.  David Duong, through his caring, helps the man and the family understand the illness, understand their options, and ultimately says goodbye when the man goes home with palliative services to spend his last days with his family. 

Duong writes toward the end of the piece:

“As a final goodbye, I reach out my hand to shake his and wish him continued health and strength.  He grabs my hand and tells me, ‘Thank you for helping me not be afraid.’ … I have also learned that by caring for the patient, by placing the patient at the center of our medical practice, we can establish a trust relationship that just might lessen that fear.”

In this essay, David Duong never once mentions costs, and my bringing it into the discussion may seem to some to be crass --as though I am diluting the message of caring and trust that is inherent in this essay.  However, I see cost and care as going together.  For me, lowering costs in ways that maintain trust and relationships is critical to good care, as it improves access to care.  Unfortunately, many of our well-meaning efforts to lower costs end up diluting trust by short-changing the time and communication critical to building and maintaining needed healthcare relationships.  David’s interaction with this family saved money.  By caring for the patient and the family, and by communicating with them using their language, their values and their culture, he helped them embrace home palliative care.  This type of situation could have easily have been much different. The fearful family and patient, not trusting the doctors and nurses caring for them, could have demanded “everything” be done, causing useless pain and cost. 

In this era of 10-minute office visits, Internet-based self-service diagnosis and algorithm-driven healthcare, I still believe that the most effective way to lower costs is to have trusted health professionals at the side of people in need.  David Duong’s essay conveys that message more eloquently than I ever could.