By Richard Propp

Since I first met you on July 31, 1965, I have been smitten with your looks, your fairness, your support of the elderly without regard to social or economic status, skin color, ethnicity, intellectual IQ, emotional IQ, address, clubs, choice of transportation, hobbies, reading list, or favorite restaurant. You took care of our grandparents, our parents, and now you are taking care of us!

Your birth was not without pain. Some of the Southern congressmen could not stand the idea of people with differing skin colors being in the same hospital room. Eventually President Lyndon Johnson, his staff, and senior citizen groups, wore down Congress, the insurance industry, the unions, and the American Medical Association, and Medicare, health care for all Americans aged 65 and over, became law. It was implemented in July of 1966. Health care was not just a necessity, it was now a right for these folks.

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By Bob Wachter

Last week’s ABIM Foundation Summer Forum focused on patient-centered care… and who could be against that? But is patient-centered care just a healthcare MacGuffin?

What’s a MacGuffin, you ask? In a spectacular talk at the Forum, Michael Richardson of Chicago’s Hines VA reminded us that the MacGuffin was one of Alfred Hitchcock’s favorite directorial strategies. Hitchcock defined the term this way:

MacGuffin:
a plot device that motivates the characters or advances the story, but
the details of which are of little or no importance otherwise.

I
loved Richardson’s analogy when I heard it, but its utter aptness
became clear only as the conference proceeded. Let’s start with the
areas of general agreement (thanks to Jim Naughton, Chair of the ABIM
Foundation, for articulating these points):

• Patients’ preferences should be respected.
• We should attend to patients’ emotional needs, context, comfort and meaning.
• Patients should be engaged and empowered.
• There should be shared decision-making that promotes patient autonomy.
• Family and friends should be involved in care decisions where appropriate.
• Care should be coordinated within and across systems.

Well, sure.

But then things became a bit fuzzier. The conference’s first talk was framed as an egregious example of what happens when care isn’t patient-centered. Margaret Murphy,
a soft-spoken, matronly Irish woman who now serves on the Patient
Steering Committee of the WHO’s World Alliance for Patient Safety, told
the tragic, infuriating story of her 19-year-old son Kevin’s needless
death. Somehow this young man with classic hyperparathyroidism
(“stones, moans, bones, and abdominal groans” – a constellation of
symptoms recognizable to any decent 3rd year medical student) was
misdiagnosed for the better part of a year, in a tragedy of cognitive
(he carried the presumptive diagnosis of leptospirosis for months) and
logistical (his hypercalcemia was noted on a Post-it Note that got
stuck to the back of a piece of his chart and went unseen for weeks)
errors.

This isn’t a lack of patient-centered care. This is
unconscionably bad doctoring, mixed with really awful systems, pure and
simple.

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