Blog | Monday, January 24, 2011

Beyond a spoonful of sugar


First there was that draconian immigration law. Then came the news about the cash-strapped state cutting Medicaid funding for certain types of transplants.

[And of course now the horrible news about the shooting rampage in Tucson.]

spoonful of sugar by truds09 via FlickrJust when I thought Arizona would legislate itself into least-favored state status, there was this article by Pam Belluck in the New York Times. The quick summary: Beatitudes nursing home in Phoenix is an outlier in the care of patients with Alzheimer's dementia, because the staff there are empowered to give the patients what they want. Really. Any time of day or night.

Chocolate? Check.

A nip of brandy? You betcha!

Grandma (Mom?) wants to play with dolls? God bless her ...

This article, part of an ongoing Times series called "The Vanishing Mind," carries the subtitle "Therapy Based on Comfort."

Therapy based on comfort? I love this idea! Ultimately, what else is there?

I find myself asking this question more and more. Health care and hospital practice is all about sacrificing comfort in the name of answers: diagnosis and treatment answers. [Hey! and let's not forget prognosis answers ...] When did medicine, like life, become "no pain, no gain?"

And this newfangled philosophy by Beatitudes is front page news! Literally.

Belluck's article splashed across the front page the same month that the ever-crusty New England Journal of Medicine carried a piece titled "The Emerging Importance of Amenities in Hospital Care."

What earth-shattering trend will the NEJM reveal to us next? "Shelter keeps people warm and dry?"

What's interesting about the way this nursing home treats its patients is, well, the outcomes:
--The patients eat more.
--They're less agitated. They wander less.
--The nursing home has therefore cut way back on its use of sedative drugs and physical restraints.
--This makes the families of these loved elders much happier.

The staff feel better about the care they're delivering, since they're empowered to try to negotiate their way out of challenging situations by giving the residents of the nursing home what they want, rather than telling the residents what they "must" do to comply with the home's (and presumably state and federal) regulations.

Okay, you say, but this is an isolated example. A nice example of a defined population (Alzheimer's patients) and a select environment (the nursing home).

But what prevents us, other than the inertia of old habits and institutional culture, from holding to these principles in other realms of health care?

Couldn't we provide patients with comfort in hospital settings? Why does it always seem to be either/or?

We move vigorously to treat diseases, but when they become resistant or the treatments themselves too toxic, why only then do we switch to comfort mode? The article commented on here is only the tip of the iceberg in poking holes in that theory.

Remember that you heard it here first: The massive federal health care overhaul (coming to you full-fledged in 2014) will alter the landscape dramatically. Health care entities that offer value, convenience, service, knowledge, and above all comfort, will sip from the chalice of health care innovation and reward.

This post by John H. Schumann, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist in Chicago's south side, and an educator at the University of Chicago, where he trains residents and medical students in both internal medicine and medical ethics. He is also faculty co-chair of the university's human rights program. His blog, GlassHospital, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people that inhabit them.