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Demystifying Medicine One Week at a Time

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.]

The 48th State; cruel to some, kind to others.

Just when I thought Arizona would legislate itself into least-favored state status, there was this article by Pam Belluck in the NY 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 it’s 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.

1 Comment

  1. What a concept! Keeping people comfortable!!

    Your excellent post reminds me of Canadian psychosocial research a few years ago that announced: “Patients feel better when doctors listen to them!”

    Dr. Harvey Chochinov’s work, published in ‘CA Cancer Journal for Clinicians’, involved what he calls The Dignity Model in caring for patients. He cites three major categories of the model:

    1) illness-related issues pertaining to bodily concerns and symptom management
    2) dignity-conserving repertoire pertaining to the patient’s psychological makeup and spiritual beliefs;
    3) the social dignity inventory, referring to external influences affecting dignity

    It’s the third category I was reminded of while reading your post.

    This includes social and environmental factors that can affect a person’s sense of dignity – for example, encouraging physical privacy, making sure health care professionals ask permission to perform a physical examination, being good listeners, and ensuring that, in whatever they do, they treat the patient as someone worthy of respect.

    That may include freely providing chocolate and brandy! More on Harvey’s research at: http://caonline.amcancersoc.org/cgi/content/full/56/2/84

    Although his particular focus was on psychosocial needs in palliative care, isn’t this list just as important for all kinds of health care?

    Thanks for this fascinating link to ‘Therapy Based On Comfort’.

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