I accidentally majored in Therapeutic Recreation in college. It was not my first plan- in fact, I think it was “plan C”. I was originally all set to major in Athletic Training, but the program was cut down to a minor just before I was qualified to begin. Then I set my cap on an Exercise Science major only to have it morph into a Physical Education Teaching track, which did not thrill me at all. By this time I had accumulated a strange assortment of classes under my belt and I went where the wind took me. Which was in the direction of Therapeutic Recreation (also called TR). I wasn’t happy about it.

All the other TR majors were equestrian types who wanted to work at youth ranches and summer camps for troubled teenagers. I wanted to work in a clinical setting and treat patients who were recovering from orthopedic injuries. I was a snob about it. I thought to myself “These people don’t have any place in the world of Medicine” (Capital M to make it seem more important). “What am I doing here”, “This is beneath me”. Snobbery of the worst kind.

But, in spite of myself, I began to absorb things in my TR classes. In fact, I learned a lot of really useful theories, many of which I use on a regular basis now that I work at my clinical job.  The main point that was hammered home to me again and again was the concept of “Patient centered care”.

Patient centered care is all about putting the needs of the patient first. This seems like it would be a basic concept, but it turns out that it is not. All too often in medicine we spend our time treating the problems instead of taking care of the people.  This is the difference between putting a brace on a mildly sprained Left wrist and treating Doug, a mailman who slipped on the ice and sprained his wrist last week.

It doesn’t actually change the treatment at all. The same brace gets used for the same injury whether the wrist belongs to a mailman or rocket scientist. It doesn’t matter to the clinic, we get paid the same amount for the brace either way. But it does matter to Doug. He knows that I am conscious of the fact that he as a person is attached to his sprained Left wrist. We exchange a few words of genuine human conversation. I made a weak joke, he snickers slightly. He walks out with his wrist feeling better and his human dignity intact.

Patient centered care is actually really hard to do in real life. This is because medicine is a business. Businesses are all about efficiency. In order to reach maximum efficiency, facts are reduced to numbers and figures.

–          This is my 7th patient this afternoon

–          She is 65 years old

–          ICD9 824.4

–          His insurance will only cover 80% of the cost

–          5’5”, 195lbs

–          We are running 10 minutes behind schedule

–          Right TKA 3 months ago

–          L4360

–          15” calf circumference

Somewhere in the cloud of numerical facts, the practitioner has to find the time and presence of mind to actually talk to the patient as a person. And people are messy. They tell you their entire life story when you are just trying to get the history of the injury, they cough without covering their mouths, they smell bad. Last week I asked an elderly patient if she had any pain while I was evaluating her knee injury. She responded with “I don’t drink. Never touch the stuff”. Thankfully she was too deaf to hear me snort with laughter. I bellowed back at her “Neither do I”. She seemed satisfied.

iron man

I saw this picture on the internet on Monday. Window washers at a children’s hospital in North Carolina don superhero costumes while reppelling down the side of the building to clean the glass. How unnecessary and wonderful! I’m sure that this action doesn’t boost the productivity of the window washers. Imagine how annoying it would be to wear a cape and/or helmet when you are dangling from a harness 15 floors above the ground. It doesn’t make a whole lot of sense from a business perspective. But to the sick and injured kids in the hospital beds, this little extra act of kindness is a big deal.

Even though the patient centered care processes can sometimes be a challenge, it matters.  Talking to the patient, getting to know them slightly and going the extra mile to help them feel that they are valuable and important is a huge part of successful treatment.  Even though it may seem less efficient, this type of approach often garners superior results. This is because people’s feelings very much effect their health. Good feelings = feeling good.

For a more in-depth look at patient centered care, I recommend this article:

http://healthaffairs.org/blog/2012/01/24/patient-centered-care-what-it-means-and-how-to-get-there/

 

Walk well.

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