To The Point

Diseases of life: Life situations act as barriers to care

Healthcare today has become disease-centric. We not only focus heavily on the biomedical needs of our patients, but we do it from a disease-defining perspective. We have pathways and guidelines that are disease specific, we have specialty clinics that are disease specific, and our treatments are very focused on treating a disease. Working from this disease-based paradigm has caused us to even view those we serve through this disease lens. You hear the words “my diabetic patient,” or “my heart failure patient.”

This perspective causes issues for many reasons. First and foremost, those we serve do not view themselves that way. Our patients view themselves as human beings that happen to have a disease or illness. Second, rarely does a patient have a single disease. Being disease-based tends to create a singular focus as we look at one disease at a time, and that’s not how our patients present.

By treating our patients from this model, success has been limited. We struggle with “non-compliance,” and patients “not understanding” or “listening to what I say.” In order for healthcare to become more effective, we need to shift our mental model of how we look at our patients. They are not a disease state, and more importantly, for us to be effective, we need to think about and treat the one disease that all people share. That one disease is the disease of life. This situation is about all the life issues that impact our patients every day that are barriers to their ability focus on their health. These diseases fall along the psycho-social axis and are also referred as the social determinants of health. We realize they exist, but historically, we have thought about them only in the context of their disease. By changing our frame of reference, we begin to look at their disease within the framework of their psychosocial situation. As we make this conversion in mindset, we will be better able to first impact those barriers that need focus and then we hopefully will have much greater impact on their disease state.

By rethinking how we view our disease-based models, we are shifting to a much more person-centric, holistic model. Patients and providers will see the value and results very quickly, and the Quadruple Aim will be better achieved. Once our perspective changes, we can build systems that support this change.

This To The Point was written by Jordan Asher, MD, MS, Chief Clinical Officer and Chief Innovation Officer. You can read more of Dr. Asher’s thoughts on value-based healthcare and healthcare reform at his blog, The Positive Contrarian.