Why we can't fix our healthcare system | Ayesha Khalid | TEDxBeaconStreet
HTML-код
- Опубликовано: 29 авг 2024
- This talk was given at a local TEDx event, produced independently of the TED Conferences. Ayesha Khalid, surgeon at Harvard Medical School and recent MBA from the MIT Sloan Fellows Program, is at the intersection of disruptive innovation in healthcare and the digital health experience. Ayesha previously pioneered groundbreaking research in sinus disease including muco-ciliary clearance and outcomes following surgery. She is now a passionate believer that disruptive innovation in healthcare requires collaboration, not competition. Using a systems thinking approach, Ayesha wants us to suspend our belief that adding more process to our healthcare system will add back "health" and "care" to a broken system. Instead, this compelling talk provides an imaginative way to approach the redesign of our health care system to one that promotes "health" and works "systematically" for the patient.
A sinus surgeon at Harvard Medical School and recent MBA graduate from MIT, Ayesha Khalid is a healthcare innovation enthusiast involved with entrepreneurial ventures at the intersection of healthcare innovation and digital technologies. She has pioneered groundbreaking research techniques in inflammation and sinus disease and is working to create different funding paradigms to accelerate clinical research.
About TEDx, x = independently organized event In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. At a TEDx event, TEDTalks video and live speakers combine to spark deep discussion and connection in a small group. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized.* (*Subject to certain rules and regulations)
The best doctor I have seen ask me what I think is going on then examines me and gives me options in resolving my concerns.
The most important part of this speech is when she covered the patient-physician relationship. I can say from experience that doctors don't take the time to build a relationship and really understand why the patient is there. As a doctor in the healthcare system, you're obligated to treat every visit separately and form conclusions from hard evidence. Hard evidence is of course what shows from the tests, but also the patient's story. If this first step was taken more seriously, I really feel like our healthcare systems will be more efficient. This might seem like a small “issue” but in reality it can make or break the healthcare system’s reputation. I’ve been to some doctors before where they assess me and get me out of there as fast as possible. That forms a void in our relationship, and made me not go back to that doctor again.
I agree with the need for a better patient-physician relationship. I work at an Optometrist office and the need for that relationship is unappreciated. It helps facilitate communication; patients are more likely to come see us when the physician is easy to talk to and friendly. Certain physicians I know are very close-minded and rude; they seem to get mad at you for asking a question. This makes the patient feel like they are doing something wrong when they are coming to seek help. Likewise, they are less likely to ask questions to gain complete understanding of the situation. This idea of complete understanding is key for the patients to make autonomous decisions. If patients are only basing their ideas off limited knowledge, they are not making an autonomous decision. Patient autonomy should be one of the main guiding factors for physicians however this is another topic.
To continue with the idea of complete understanding, I believe that this is key for a healthy physician-patient interaction. Most of the time patients tend to like understanding what is going on; not knowing what is happening causes most of the fear, anxiety and dislike of a physician. Some Doctors have a hard time with explaining in lay terms. They are so trained to speak in medical terminology that some physicians have a hard time helping the patients understand what is going on. We have patients that travel across the country to go to an optometrist, someone they could really go anywhere and get care. Overall I believe that patient interaction is key to a healthy relationship.
Getting to know a patient and their situation is one of the most important things when a patient comes in. You should get to know your patient personally because that is a part of your everyday job. I feel as if doctors do not want to get personally connected with their patients that is a huge problem. It is the doctors job to make a patient feel comfortable because of the sickness that they are going through and because a patient should automatically feel some type of comfort around any doctor. Many patients go to other doctors where they feel that they cannot get that personal connection as if they were with their original doctor. No one ever wants to go to the doctor feeling like they are being rushed out with unanswered questions and feeling like their problems are not being fixed. From experience I have had this happen to me where I have been to a different doctor and I have had a problem occur where no one could tell me what was going on. I had different test run on me and no one knew what was going on. I had heavy breathing and I was getting sick continuously. The doctors just assumed that it was just a cold and a slight case of asthma. They prescribed me some pills and an inhaler. I was told to use my inhaler every four to six hours and I will be fine. Until this day I am still not sure if I have asthma or not but when my chest fills tight I just take use my inhaler because that is what the doctor told me to do.
repeat appointment's make money.
I'm not sure if this is part of Residency training, probably the opposite.
Had my Doc for many years now but sadly management keeps changing. Our appointment times keep getting shorter and basically everything is now on a fifteen minute schedule block to get in as many patients as possible. Doesn't matter how long you've been at the clinic or how far ahead you scheduled. Corporate greed is constricting so many GOOD Docs.
all aspects of health must be taken into account because health is not just the absence of the disease in the human body, we must go towards the promotion of health
"Asking if we are asking the right questions is so true." I see so many times from the entrepreneurial perspective that people just dive right in on specific solutions with no regard to the bigger questions of "why"?
Arthur,
Thanks for the insightful comment! User Design is very lacking in healthcare and just yesterday I had a conversation regarding the fact that we need to have a good analysis of the needs before producing a solution! This is commonly done in software development and the quick iterative process is something to learn form in healthcare!
Thanks,
Ayesha
Great points, Ayesha! The biggest take away for me is remembering to slow down, ask questions, and look outside of the immediate problem area.
Meghann,
Absolutely and the work Somerville NEXUS group is doing regarding systems thinking and improving the healthcare of its citizens is inspiring!
To answer your question: why aren't the Charlies of the world getting the necessary diagnoses? I offer this response which is based on both personal experience as a patient and a fellow healthcare professional. Apologies if the answer appears emotional but I am passionate about delivering care and it peeves me that professionals at times stumble at the most basic of principles: listening to the patient; I totally agree with you on that one. The first thing we are taught as nurses is the importance of communication, delivering information so the patient could understand it, benefit from the treatment and make an informed decision. the second part of communication is listening; not only hearing the words but attentively and seriously. My personal belief is that most doctors are problem solvers; as they listen to the patient, they are 'solving' the case study they are being presented with. The flaw here is that this is not holistic.
I hold my hands up, as a student, I was given that exact feedback: "the patient could hardly breathe and you bombarded him with 20 questions!". My reply " I needed information so I could help him". So, although the intention is benevolent, the application was lacking and non-holistic. Another point, is that the patient is the one who knows exactly what they are feeling or experiencing even if they can not provide a self prognosis or name the cause of their current predicament. This is where the 'listening' part comes in. Listen to what the patient is saying and ask probing questions in order to hone down on the symptoms. Do the tests for pete's sake! Not just because you failed to determine what is going on but as a precautionary measure (forget cost!). If certain causes are ruled out early on, this would prevent diagnostic overshadowing or failure to diagnose and limit the number of people returning with more serious conditions.
Apologies again for the emotional rant, but doctors have to stop believing they know better than the person who is going through the ailments (in certain cases), and hone their social and communication skills. I understand pressures and demands of the job could lead to some form of malignant alienation and a coldness on the doctors part but the patient remains a human being in need of help; and they are reaching out. Instead of the conversation flowing between adults, it becomes a parent-child interaction: 'take this because I say so, you don't need to know why'.
Consider this event which happened to me the other day during a suicide prevention lecture: the lecturer made a statement that during the first two weeks of administering anti-depressants, the 'subject' may experience increasing suicidal thoughts and requested that doctors be mindful of this while informing patients as they prescribe the meds. The shocking response from a doctor present was: but research shows that 'prescribing someone a pill as effective as offering them talking therapy'!!! Shocking and mind blowing insight into how much faith doctors have in pills but not enough in human contact (and into how some doctors think). I hope more people stumble on your lecture and appreciate the importance of establishing a therapeutic relationship/partnership with the patient so instances of misdiagnosis would be a thing of the past. Thank you.
I especially enjoyed the point of view that Dr. Khalid took that healthcare is a partnership with your patient. It is a good reminder as a future healthcare worker to slow down, listen to our patients and really listen to what they are telling us. Physicians are always taught to first do no harm, but in a world that is continually pushing healthcare to become faster and more efficient we lose sight of the most important part of healthcare, the patient. Patients are not going to feel safe and willing to open to their doctor if they don’t feel like they can form a connection with that person. I agree that the first steps to solving our issues with healthcare is to begin by asking the right questions and looking into how patients are being treated by their physicians.
Thank you for listening and look forward to your thoughts!
I appreciate Dr. Khalid’s question: “Are we asking the right question?” To really do our work effectively, we have to take the time to ask the right questions. We have to consider the patient’s full story, and not be hyper-focused on a certain symptom or a certain part of the body. I think it’s an ethical imperative for each physician to take the time to get to know each patient in order to be able to provide the best care. Without knowing a fair amount about your patient, it would be very difficult to effectively treat them. That’s what leads to misdiagnosis and errors. It seems in many instances it would be better for a physician to take a little more time to fully understand the patient’s story instead of trying a whack-a-mole approach of quickly guessing at a diagnosis and hoping it’s right as you send them out the door. It’s our ethical responsibility to try to do better. It’s also our obligation, as Dr. Khalid suggested, to be willing to admit when we don’t know and commit to keep trying instead of just sending the patient out the door with a medication that likely won’t help. We also need to be willing to ask for help from colleagues and collaborate to find what’s best for each patient.
Those were great points! The conversation between the patient and the doctor should be more about listening than hearing.
I agree very much with Dr. Ayesha Khalid in her stances on the modern day health care system. Her approach to better the health care system could really make a difference in how doctors treat and assess their patients today, and could also really help with failures in the system. In the video, Dr. Khalid talks about a personal story with a patient named Charlie. Charlie went to her office seeking help that he has not received from many other doctors. He then explains to Dr. Khalid how frustrated he is with the healthcare system because he has been to so many doctors and specialists and not one has been able to tell him what is wrong or diagnose him with anything, and he knew something was wrong. Dr. Khalid was very bothered by his frustration and reassured Charlie that she will end his streak of being let down by other doctors. She tested him for everything she could think of with his symptoms and every test was coming back normal or negative, so she then ordered a CAT scan. The CAT scan did not seem to be necessary with all the work she had done prior to, but she was not letting Charlie leave without answers. When the results came in from the CAT scan, everything seemed fine, but that was not good enough for Dr. Khalid. She went through the images herself and ended up finding a mass on Charlie's brain. As she told the news to Charlie and his wife, Charlie felt a sense of relief and thanked the doctor. Charlie's reaction speaks volumes. He was RELIEVED to find out he had a mass on his brain only because he finally got his answer. This addresses the problem that Dr. Khalid is attempting to fix in the healthcare system. Doctors not taking the extra step in finding a diagnostic for a patient mainly due to the fear of failure. With this problem in mind, Dr. Khalid proposes three questions; How can we get doctors and patients to talk as friends, why is it that competition is so bad for health care, and why does the medical field fear failure? An answer brought up that addresses all three questions is that we need to make doctors more focused on bettering the patient and not themselves. Directed at the first question (getting doctors and patients to talk as friends), doctors need to be willing to take the extra step in getting personal with their patients so they are comfortable to tell them that they might be unsure of the answers for them at the time, but will do everything they can to get them their answers to solve the problem. In turn, the patient needs to be willing to accept the doctor's answers and understand that they will do anything possible to help. To address the second question (competition in healthcare), doctors today are more worried about getting higher up in their practice and making the most money than connecting the right way with their patients. This is not to say that all competition is bad, some competition can be positive as well as some can be negative. Some positive aspects of competition is that it weeds out the weaker party trying to be doctors in which is a big part on what is saving patients lives to this day. Another is that it makes doctors strive to be the best at what they do, meaning they will gain more patients and in turn gain more experience to help further them in their career. The problem is, is that there are overpowering negative factors to competition and that the negative factors tend to be more commonly noticed than the positive. One negative part of competition is that it turns doctors and other medical professionals against one another, which denies them the opportunity to gain knowledge from fellow superior or non-superior colleagues. Another negative aspect of competition in healthcare is it brings more of a focus on social gain such as status, ranking, or money earned. As said in the video, doctors need to focus on gaining better relations with patients and fellow medical professionals to help them have a better chance of succeeding in their career. By doing this, it will not get rid of competition as a whole. It allows you to take Dr. Khalid's advice while still preserving the most important positive aspects of competition while also allowing us to remove the negative aspects. To address the final question (medical field fearing failure), this connects all the points Dr. Khalid made together. Doctors in today's world are so afraid of failure, they settle. They settle for the easiest route, whether that be diagnosing too quick, or not giving any answers. There is currently a 15% chance of diagnostic error on a patient's first visit with a physician, as said by Dr. Khalid. By implanting these questions in the healthcare field, that rate could drop tremendously. I strongly support Dr. Khalid with all of the points and solutions she addressed in the video. She allows her audience to see all different angles and perspectives of the topics she discusses which gives a fair opportunity to decide your stance on the topic.
hello I!m from the uk in this country we give our doctor as much information as we can so he/she can make a diagnosis and direct us to a solution and treatment without fear of the costs.however in your country maybe patients do not disclose for fear of high bills or affordadlity ostrich and sand .
Excellent presentation!
I do agree with Dr. Khalid when she says there is something they need to fix in healthcare. She understands how frustrating it may be to not know what is wrong with you and to not be able to figure out the problem. The patient and doctor both want answers and want to figure out the diagnosis. Also, the patients need to understand it will take doctors some time to figure out what is wrong with them. Sometimes it takes days or weeks but they need to be patient. Doctors also need to know they will fail but can learn from it. Doctors will not be able to satisfy every single patient that comes through the door. I believe Dr. Khalid is right when she says they need to change the nature of the conversation and ask physicians to make the time to step back and listen to the patients stories. Nothing should be rushed.
I agree with you, doctors are not perfect and must learn from their mistakes. But at what cost? Doctors need to spend more time with patients instead of rushing their diagnosis's or treatments. More conversation between patient and doctor could lead to more accurate diagnosis's and maybe even better prognosis's. Health care should always be about the patient's best interest. Not what is more timely.
I agree that doctors need to spend more time with their patients instead of rushing treatments. Better prognosis's could result in a doctor that gets better results.
Thank you
One very important part discussed in this video is the patient-physician relationship. I know from personal experience that sometimes doctors really lack in the bed side manner part of training. My doctor back home is not very friendly and that makes going to the doctors even harder. She always has this tone in her voice they she doesn’t want to be there and it makes me feel bad sometimes like I am wasting her time and that’s not okay. Doctors are supposed to make you feel comfortable, like you can go to them with every and anything. She just seems like an all around grumpy person. I know personally I would feel much better as a patient if my doctor was cheery and happier.
Ayesha Khalid's first question, to me is the most important aspect of health care. The patient-physician relationship is the first thing that should be analyzed, and I feel should be focused on more. Doctors don't take the time to build a relationship and really understand why the patient is there. Yes there are plenty times when people get checked out and its not severe. But as a doctor, you're obligated to treat every visit separately and form conclusions from hard evidence. Hard evidence is of course what shows from the tests, but also the patient's story. If this first step was taken more seriously, I really feel like our healthcare systems will be more efficient.
I agree with you that the patient-physician relationship really needs to be focused on first and definitely more. While I do sympathize with the fact you feel doctors don't take the time to know their patients and truly build that relationship with their patients, but this is unfortunately part of our health care system. We are focused on how efficiently we can get patients in and out of the office so we can get the most amount of people what they need, but this ultimately affects the thoroughness of their treatment in some cases.
Excellent thoughts. Very true that physicians feel strong time pressures in dealing with patients. i also recall our conversation about how patients need to self-advocate and not assume that the doctor's initiatives in solving medical problems are correct. We talked about the many options that cancer patients are presented and how difficult it is to navigate these options without good guidance.
Thanks David! Agree that self- navigation as patients in a time of extreme vulnerability is difficult. And physicians need the tools from a social work standpoint and insurance systems standpoint to help their patients. Perhaps that is why new models of care are emerging as featured in Time Magazine recently. Happy New Year!
Excellent points. It reminded me about the manager's mantra "Don't come to me with a problem if you don't have a solution". A big mistake in my opinion, which threatens effective communication and limits problem solving in both organizations and in the physician-patient relationship.
Leonardo- I hope you are enjoying applying system thinking in your work! Problem solving is certainly a skill that is critical to the patient diagnosis.
The doctor cannot read your mind. You have to tell the doctor all of your symptoms regardless if you think it's not important.
*Please pay an additional $99 in order to see this content.*
...and be happy it's not $100!
I had this happen to me. Was the victim of an assault, guy broke my nose. first doc throwing meds at it, and then finally ordered a CT said nothing wrong, second doc looked at the CT saw that my airway was the with of a sowing needle, said go to see a plastic surgeon. Surgeon 3 hr north looked at CT and said she couldn't touch it identified that the septum was bent into an S shape, and was shoved to within 2mm of my brain. She refereed me to Georgetown Medical school, the head of Maxilla facial surgery, who was the only one qualified to repair the damage.
I
was extremely intrigued by Doctor Khalid’s approach to better the modern day
health system. She went in depth of a personal story of an interaction with a
patient that was having trouble getting his symptoms diagnosed. This patient
has gone to multiple previous doctors in hopes of figuring the problem out to
no avail. When this patient went to Doctor Khalid the process seemed to be
going down the same road, but Doctor Khalid ordered a CAT scan even though her
medical knowledge of the situation in the current frame of mind told her that
this was a wild goose chase. At first Doctor Khalid didn’t see what she was
looking for in the imaging, but due to her determination to find what his
discomfort was, disregarding the tendency to stop searching, Doctor Khalid
arrived at the problem. When Doctor Khalid told him what was wrong the man didn’t
look sad (as what you would expect). He was happy, and the man thanked the
doctor for believing what he was saying. Now this story she goes on to say that
the competitive nature of the current healthcare system is a huge factor in
misdiagnosing patients. The road an individual has to go down to become a
doctor is extremely competitive and creates a tendency to only focus on a very
specific area of study. It essentially puts blinders on the doctor, and this
she believes is the reason for the fifteen percent misdiagnosis that makes the
chances of illness and death twice as likely. Continuing this frame of thinking
will not fix the problem. Einstein has an enlightening quote used by Doctor
Khalid saying, “We cannot solve the problems by using the same kind of thinking
used when we created them.” So how does she change the frame of mind to solve
this problem? The questions she believes must be asked to solve this problem
are; how can we get doctors and patients to talk as friends, why is it that
competition is so bad for healthcare, and why do we fear failure? Let’s take
the first one for instance, and get the patient to talk to the doctor as a
friend. What can be the perceived result of this action? I believe this action
will result in a better relationship between the doctor and the patient. Which in
turn will make the patient more open and share very specific details that would
not be shared otherwise. Therefore giving a wide spectrum of information the
doctor can better make a decision in the diagnosis due to taking Einstein’s
suggestion and tackling the problem from all angles by combating systematic
thinking that has led to misdiagnosis, wrongful prescriptions, and not fixing
the problem. The next question brings to the forefront the negative effects of
competition in healthcare. As discussed before the current competitive system
causes the doctors to approach and fix the problem solely by focusing on their
specialty, not the problem itself. The doctors tendency when troubled on a
problem is to go deeper and deeper into their own specific practice, and if no
answers pop out they will dismiss the patient due to systemic thinking in a
practice if the symptoms don’t match the criteria there is no problem (or a
problem that doesn’t need medical attention). I would also like to bring the
positives of competition in the state of fairness to give us a prospective on
the truth. Competition in healthcare will bring out the most talented
individuals, and weed out those that could prove incompetent in that field. This
reason alone probably has saved so many lives that would have been lost otherwise.
Next competition in the health field will keep a monopoly at bay and therefore
makes healthcare more affordable. The last positive thing on competition in the
healthcare is the drive for the doctor to be better than the surrounding
doctors to gain more patients, indirectly giving the patient better care than
if there was no competition. I believe the problem presented by Doctor Khalid
is important and healthcare should always strive for perfection and the answer
is not to take away competition, but instead create greater relations between
practices as well as patients. This way you can take Doctor Khalid’s advice
while still preserving the positive aspects of competition. This system will
allow; the patients to speak more freely to the doctor, the doctor to get a
prospect view of the patient’s situation, and allow the doctor to get a wide
range of specialties by discussing with other doctors (but specific identities
should still be preserved by HIPPA). The perceived result would take the pressure
off the original doctor, and discourage rash inaccurate diagnosis. Now the last
question Doctor Khalid brings to our attention is why do we fear failure? Now she
doesn’t go in depth with this question but I believe it is more of bringing
awareness to the fact that we can’t stand taking defeat. This can be dangerous
in the health field if this fear of failure is to come up with a diagnosis. I
believe the previous suggested plan would decrease the fear of failure’s
negative effects on doctors by allowing them to admit “I don’t know” to their
colleagues as well as allowing the patients to give a thorough description of
the problem.
Thank you for this thoughtful presentation. We need many more inspiring, engaging people like this fighting for better, more holistic health care, and for universal health coverage. Just imagine someone like her as surgeon general.
Dr. Khalid,, A wonderful presentation with many answers to our HC problem, indeed. I like your idea of Einstein reference and partnering with our patients. I agree that we as physicians cannot be as effective as we can in partnering with the patients we are trying to help. I often tell my pregnant patient, that I can do only so much by seeing her so often but she is in charge 24 hours a day and if properly instructed and inspired to partner we can go much further on our journey to reach the goal of normal and healthy baby. You are also correct that small thing if done together much like tiny rivets on the huge airplane will enable its wings to carry a huge load.
Ayesha states that in order to approach the health care crisis you need to think outside of the box and figure out what is wrong with people. She gives the statistic that 11 people die per hour from a medical error. This is very interesting because a handful of the audience raised their hand when Ayesha asked “how many people have gone to the doctors and the doctor has told you they do not know what is wrong with you?” She then talks about her idea more in depth, sometimes the doctors are rushed to see so many patients that they miss something very important. This is where her statistic above comes into perspective, medical errors are acceptable because they do happen and that is acceptable. Although some errors are able to be prevented, they are likely to happen. She elaborates that errors are where competitiveness does not help the health care system. Rushing through patients is not helpful to any patients, rushing will sometimes cause errors. The point that she raised about competitiveness is very interesting because for most people, being competitive proves that the doctor is the best in their field and they are more likely to get their ideal job opportunity. But for others, competition is not ideal or important to them. Some doctors, like Ayesha, care about the patient’s experience too. The patient’s experience is important to many doctors but ideally, most doctors want to find the cause of the problem and move on to help the next patient. Some parts of this video are very relatable, but others are hard to grasp how it is holding our health care system back.
Gibby Vogel * Like the doctors of the old west, they had lots of time to be with a patient. And their modalities were eclectic. Look it up.
This is about the 20th Ted Talk I have seen about docs taking time to really listen to patients. I know the system is flawed (I'm a nurse), but seriously how many of these are needed before something changes? These docs brush off patients, they brush off the nurses, etc. Only when the patient is expressing frustration is something done. Over it. We have a growing problem of patients treating us poorly and verbally/physically attacking us, but if this is the only way they are heard, it will continue to escalate.
Prior to watching this video, with the title stating "Why we can't fix our healthcare system" I wasn't certain whether Dr. Khalid would be addressing many issues throughout the entire health system or a particular, more direct topic. I found the topic of doctors to have a better understanding of their patients and working with them for each diagnosis, to be very insightful and something that I can agree with that needs more focus. As Dr. Khalid referred to how there is many physicians that are unable to help the question mark cases, it was a good point that the patient and doctor need to work together. If the physician is only trying to find an answer because they feel pressured or for the sake of their job, rather than actually wanting to help the patient and find the answer for them, they are less likely to gain all information needed and work towards the final goal. I can also see as well though how the patients can be partially at fault if they're more angered as to that the doctor isn't fulfilling their position and unable to help them and expecting them to know instantly. By both the patient and physician having the same understanding and taking the time to ensure the correct diagnosis, there would be many less mystery cases.
This talk was quite interesting and did make some really good points, but I admit, I didn't think it would discuss this. I opened this video thinking that what needs fixing is how in the US healthcare system money comes before patients' health, and good treatment is a luxury rather than a inalienable human right.
Doctor's errors are indeed something that needs to be faced, but I really wouldn't think this was the #1 problem in the US healthcare system. Coming from Europe, it didn't even cross my mind that this would be the main issued discussed in a US-based talk!
Reading the title of this video, I thought that this lecture would consist of insults and negative details about how the lecturer thinks the system is failing. Reluctantly, I was pleased to find that Dr. Khalid's presentation was actually about the ways communication can solve seemingly simple problems. Her statement about how the way health professionals should treat to reaching the final diagnosis should be like a pass the baton kind of transaction, is a very interesting proposal. It does, however, prove to be true when I think about the way my information travels through the healthcare system; myself, to the doctor or physician, to the hospital, to pharmacist, and then to the healthcare provider. It is a very race-like transaction, and that is where Dr. Khalid's
idea of having a longer conversation with doctors shows beneficence. Just by her suggesting that sharing more information with a doctor could be rewarding, the benefits would come when I would get an appropriate diagnosis.
I agree with Dr. Khalid that there is a lack of communication between patient and physician. Patients want answers, and physicians want to give them those answers. She made a good point when she said that the patient and physician need to partner together. Patients need to be more aware of their health, and the healthcare they're seeking, while physicians need to specialize patient care, and not generalize it. Patients need to allow medical professionals to work through their healthcare issues and understand it may not be a quick solution. The patient-physician relationship needs to grow stronger in order to "fix" our healthcare system, and patients should always feel open to question their doctor's treatment plan or diagnosis. You should always be your own patient advocate.
I agree with you, Ciara. I also think there is a lack of communication between the patient and physicians. I believe one of Dr. Khalid's points of this is to explain how doctors need to take the time to listen to their patients and the patient needs to give their doctor time to figure out what is wrong with them.
Yes, until patients and doctors relationships become more connected, I feel there will be an ever-growing gap between them that can, and will lead to improper diagnosis, treatment, and care for patients.
I think that this video touches on a few good points about patient and
healthcare provider interaction. Today's society is all about results and turnover rate: the more people helped, the better. This unfortunately leads to misdiagnosis and can lead to further illness or death. Patients
shouldn't feel rushed when going to the doctor and doctors shouldn’t
rush to see patients. Time needs to be taken on both sides to interact
and listen with care. Patients need to understand that the doctor might
not always have an answer for what the patient is going through and the
doctor needs to understand what the patient has been through. When doctors don't know what the diagnosis is, it is important for them to tell the patient that they don't know but will do everything they can to figure it out. Patients just want to understand what they're going through and to have a doctor guess rather than level with them and say they're not sure is a huge mistake. I think that if healthcare providers take more time to really understand and relate to their patients they will end up providing the best care necessary even if they don't know all of the answers.
When looking at our healthcare system it is quite complex. Because there is such a rigorous process in the healthcare system in things like diagnosing and actually finding problems with patients, there is always going to be that struggle in diagnosing patients. I agree that we cant solve the healthcare system because we haven't been asking the right questions. The three questions that Khalid introduces gives at least a push in the right direction to make an impact on healthcare. Looking at the first question it is important that we know how to talk to our doctor and to receive the right diagnoses. It is important to structure the conversation and to realizing why symptoms are happening. Changing the nature of the conversation and coming up with key points and not rushing the situation. Healthcare and its competitive nature make it almost impossible to change it. Focusing on individual performance, doctors may not know what is wrong with a patient and should be able to say "Let me find out what is wrong."
There needs to be a partnership between the patient and the doctor to realize what is going on and to impact the healthcare system in a more positive way. So, even though the title of this article says we can't fix the healthcare system, I believe through the connection with the doctor that Khalid brings up will put it in the right direction. Maybe not fully fixing the system, I believe that asking the three questions is important in looking at how we can try to fix the healthcare system.
I believe it's not just a problem with the health care system but with the patients as well. Patients expect that the doctor will know exactly what's wrong in a matter of seconds which puts a lot of pressure on them. To be as effective as possible patients and physicians need to have a mutual understanding of the situation. In order for the patient to get the best care, the doctor needs to take the time to listen to the problem and carefully go over the tests so they can reach the correct diagnosis. Being in a pressured situation and jumping to conclusions right away can prove to be incorrect and possibly even cost someone their life. In today's world it will be very difficult to fix this problem because everything is based on deadlines. Your appointment time is only so many minutes long so the doctor has only that long to try and figure out the issue. Yes you could have longer appointment times, but that will only cause other issues because there's many patients to see and only so many minutes in a day.
I completely agree with you. I also believe the health care providers are not the only ones who need to change
it’s the patients who need new perspective as well. We as a society have grown used to instant gratification and the idea that we cannot have something when we want it frustrates us. What’s worse is that we seem to have lost our empathy. We no longer see our doctors as people, but as tools to be used for our own personal convenience. Both healthcare providers and patients need to come together to form a stronger bond and create a more effective and pleasant experience for both parties. I also agree that this pressure patients put on the doctor to make a quick diagnosis may lead to an incorrect diagnosis and an incredibly dissatisfied patient with a big doctor’s bill that they feel they shouldn’t have to pay. Then of course there is the issue with appointment times as you mentioned. Healthcare providers are already short on time as it is and a longer appointment time is only a temporary band aid which will lead to further issues. Dr. Khalid herself told us during her speech that she was already an hour behind schedule when she was finally able to see her patient Charlie, which only enhances the disgruntled attitudes many patients have at the doctor’s office. A longer appointment time only means that doctors will be able to see fewer patients in a day which means that the wait period for scheduling an appointment will be even longer than it already is. The concept of wanting a stronger doctor-patient relationship is an excellent one however the path to achieving this still needs fine-tuning and we as patients need to realize that this is going to be a joint effort and we cannot expect healthcare providers to reach this goal on their own.
I agree with you Jess R that there isn't just one set of people that need to change in order for the best care possible to be provided to the patients. It requires the patients and health care providers to both work together to create the best outcomes. Also I agree that providing a good enough amount of time to a patient is important, but also realize the effects of giving one patient more time and the next one less time. The healthcare providers need to make use of their time correctly and address all problems the patient has effectively and efficiently. The patient-healthcare provider relationship is extremely important to both sides. The healthcare providers should want to provide the best care possible and have a good reputation among the healthcare community. But also the patients using that specific healthcare provider want the best care. A positive relationship between these two can lead to great health care and reduce risks of error.
I agree that patients want answers and they want them here and now, and sometimes that is not how diagnosing diseases, or illnesses works. Doctors need more time with patients to be able to fully assess their needs and treat them. Doctors are put under an immense amount of pressure with patient load and timeliness, and until this is resolved, I believe that there will be continuing problems in health care where the patient is not satisfied.
These are points I have asked my doctors for 20 years to do. Rather than a canned diagnosis...I knew there was more interrelated than had been discovered. I am hoping now that doctors have found I was not crazy oro just bent on fighting what they were saying, rather I w doing everything and it was not working, that there was more to it than had been discovered. In the past fie years, the psh i did between my cardio and cardio surgeon has actually forged hem to have a dialogue that stopped the competition to have a partnership apprehend. The competitiveness between doctors and the politics and profit/loss ratio is what is killing people in this nation. Having a holistic approach is the only say we will end this process and patients not being so willing to just listen and walk away to do what they order. Push back for logical answers until you find them.
I think the problem we have with our healthcare system is that we have a fee-for-service system an incentive for physicians to provide more treatment, more tests to charge people. So in a sense it's a sick care, not health care.
I'm not sure if an improved physician-patient relationship is going to help. We have physician to patient ration way too low. And physicians have spent a lot of money and time to get to where they are, so their time worth a lot of money and they wouldn't want to simply get acquainted with all stranger patients. I think It would cost a lot more to the systems.
Perhaps, if we can somehow make a robot doctor (AI around the corner, Alexa, Siri) that's ruled based, affordable and accessible to everyone just like a computer, that'd be a real disruptive innovation.
We know the system is broken bc some doctors think they are G_d, and won't admit when they are wrong. I lived with an arrogant spouse who seemingly was nice to his patients and colleagues he wanted to impress. On a professional and personal note, I have been lucky to have had great primary care physicians. One of them gave my son a baby gift as an infant. This Internist went on to become the first female President of the AOA and Dean of a well-known medical school. Dr. Karen Nichols is admired by so many in the field of medicine. She is respected for the right reasons.🥇⚕️
I have something that doctors don't know what's causing my symptoms. It sucks!
Ayesha, I enjoyed your presentation, and I appreciate your three points from a systems thinking perspective, especially the third point. However, I don't see ST (and your three points) as the *most* relevant aspect of diagnosis. What stood out for me was when you said, "I was curious." Don't sincere curiosity about a patient's health encourage those three points (and others)?
It seems to me that physicians prescribe drugs too quickly. Perhaps they should be more curious like you.
Duane,
Yes and thank you for the comment. It is hard to pinpoint which three are of greatest relevance and I suppose the underlying premise behind curiosity is having the time to stop - pause and have a conversation with the patient. Medicine turning into an enterprise where the last thing being increased is quality time with the doctor is why I think that having a conversation is so important. Thank you again for your support!
And continue the conversation. Patients are getting empowered which I love!!
Ayesha
Nice point to focus us. Lot of problem and disease occur in our absence. And also our health care problem. Specially Doctor's ignorance. For example Doctor 's are so busy them self and also with money they forget their moral and profession.
I wish there was a bit more direction in this video than "lets re-think our approach" etc.
Something like real life examples of where a different approach was taken successfully would have been good.
Also competition in itself is definitely NOT the problem
If the AMA & universities keeps restricting training quotas for Doctors - obviously the shortage will continue and the pressure to get patients in & out will too.
So:
More Doctors need to be trained, and more should be encouraged to become specialists
Nurse practitioners should be allowed to administer routine checkups & procedures to free up the system
A more cash based system where the PATIENT in charge is needed to encourage personal accountability and less waste
Excellent points raised here - as we struggle to find the balance of specialists in our country, it is important to realize that we need certain specialists and patients need access to them. The reason I did not offer more concrete solutions is that we have many good individual solutions all working in individualist ways. By simply taking a step back and working on the coordination of care in a systematic fashion and by allowing us to have an open conversation with our patients, it may save much of the angst that follows for the patients' experiencing our healthcare system.
No Ayesha, we don't need more "conversations", or more rounds of your 5 day Hilton conferences where no specific solutions are identified, and diplomatic double-talk (such as yours) is the only expression.
As explained, we need to either raise training quotas or scrap the AMA altogether.
Where I do agree with you is your point at 6:29 - but again that strengthens my argument. Less regulations, higher quotas and more SUPPLY of specialists would mean more lower costs and more availability to have lengthy conversations between patients and specialists.
I congratulate you on getting 7,000 views on this video, with so few comments pointing how pointless your presentation is.
I think this comment hits everything on the head!
1. The US is heading towards a shortage in physicians and other healthcare workers. It shouldn't be so expensive to become a doctor [this deters many candidates] because then we need to pay them exorbitant amounts, and then they seek high paying positions that can pay off their debt which causes maldistribution. For example, very few want to practice in rural towns and such.
2. As an immediate solution, we should also encourage task shifting, like you described, and this will free up more physicians.
3. Misuse of healthcare by patients is common and driving up health expenditures especially since the price of healthcare services are so ambiguous.
I would also recommend the book _How Doctors Think_ by Jerome Groopman. It gives real-life examples and scenarios that show how patient outcomes can improve if they learn to work with their doctors to find a diagnosis, instead of pressuring them for an answer.
A doctor shouldn't get paid if they don't get the diagnosis correct. Otherwise, why do anything different?
It is all inflated prices, well at least for an MRI scan.
The True Value is $500 or less.
Try to ask how much will it cost.
root cause analysis?
my doctors is full of locum so not a personal relationship at all, i have actually had 3 separate things brought to my attention bymy pharmacist (Susan), who knows me by name, daughters name, where i live etc
And OUR Healthcare system is Still the Best Healthcare system in the World! BAR NONE !
ROFL!!! There are dozens of countries that have better healthcare. What we have is far and away the most expensive healthcare in the world. Climb out from under that rock and get some facts before you make such a ridiculous statement.
@@Kenton1313 that's why people flock to the U.S. for medical care. Send Obama another fan letter.
@@melvinhunt6976 Then please explain to me why 1.4 million Americans went abroad for health care last year. And again, try knowing your subject before spouting Republican propaganda. And no I'm not a Democrat, I am a moderate who despises both parties equally.
@@Kenton1313 lve never heard anywhere about Americans going other places for health care. To get cheaper drugs doesn't qualify, and our opioid crisis is because of tainted drugs from said countries.
So why is US life expectancy ranked 46th in the world? Behind Cuba, Lebanon and Estonia. Good work guys.
But I saw Jeanne Pinder calling around and getting the prizes way down .
See her Video:
What if all US health care costs were transparent? | Jeanne Pinder
European Health System
An Explaination and Its simple.
If we compare the EU to the USA structure in terms of cost to GDP, Europe average 11% of GDP to the USA 20% of GDP, (2019) with the EU at 99% coverage and with improved life expectancy rate, compared to the USA.
In America USA, the health system is profit run for the most part and privately handled. Patient care is secondary to profit for 50% of coverage.
The EU system is state run, and covers everyone, from birth to death and costs half of the USA system. And USA life expectancy is 42th in the world on the world ratings.
Therefore a % of the health cost is based on profit to be paid out in dividends.
Additionallly not all people in the USA are covered, (approximately 15%)
Its a Bum deal for Americans. It costs 8-9% of GDP more than Europe.
WHATS IN IT FOR THE EU PATIENT
If you pay taxes, and contribute to the central government POT, you are covered for all treatment, hospital costs, surgery, drugs, implants, chemo, post op therapies, cost of prescribed drugs, specialist and normal GP doctors bills, specialist bills etc etc. (There are some small exceptions.)
Its all included.
The system is rated as better than the American system as nobody is excluded and the system covers 99% of all patient needs
THE EUROPEAN SYSTEM HOW IT WORKS:
All european health systems are government run and are simple systems .
It is a central, run by the govenment covering all healthcare needs for the population and is non profit , universal, and also internationally recognised between all EU countries.
The EU underlying system is through fiscal residency of a person, (ie you pay into the employment tax system of the country you live and into health system )
Simply each person pays into the THE GOVENMENT POT as a % of individual pay packet contributions where you are employed. As a registered unemployed, you are covered. Importantly even if you are unemployed.
Importantly you are still covered. you as a patient get equal rights and coverage across Europe.
The state (country) is the employer of all health staff, doctors, nurses, etc.
Central government then covers the hospitals costs through a system which keeps the hospitals covered for the expenses of each patient.
HOW IT IS MANAGED:
Central Government in each country collects the money through the taxes you pay as a citizen, and redistributes it (generally) to regions ,hospitals, and doctors etc which then distributes the funds to the health system used by the patient.
The Government also allows the private sector to operate under the public system, to build hospitals, run them privately. Each country allows this in different rules, like Germany/UK/France etc. They are then licence to operate by the government.
But importantly, the patient who pays to the state contributions through his salary, has equal rights to access all hospitals.
10% of the EU health system is private. IE If you wish to pay an additional supplement, you are allowed to do this into to the private scheme on top of your mandatory state payments so you get private health care coverage. But you cannot opt out of the central system.
Most of people dont have the means or desire to pay private insurance policies.
WHATS THE BENEFIT
Basically theEU system covers 99% of people and costs the half of the USA system. In addition to this, with the EU system, if you pay contributions to the health system in the UK or France, you can have full medical care in Germany, Italy, Hungary or any other of the 27 states.
If you lose your job, you will still be covered. you just pay less to the system as unemployment reimbusement to you is less, you pay less, but the more you earn at work, the more you contribute to the central system. Its based on % of earnings.
These European systems are based on the old and original UK system, The National Health Service, abbreviated to NHS, was launched by the then Minister of Health in Attlee's post-war government, Aneurin Bevan, at the Park Hospital in Manchester. Aneurin Bevan, Minister of Health, on the first day of the National Health Service, 5 July 1948 at Park Hospital, Davyhulme, near Manchester.
THE REAL ISSUE
1. EU Health is non political, non profit, more efficient and cheaper that the USA system,
2. BETTER in many ways, as the patient is first, and health has no “profit COST”.
3. It reduces the cost on the Government. (11% against the USA 20% per year GDP)
4. Its not fragmented. Its coverage is national, and for all.
5. If you are REGISTERED as a TAX payer, you have no problems.
6. If you are clandestine, then you get some emergency humanitarian services only.
Thus the authorities know who you are and send you home after.
Healthcare is a guessing game. To make money doctors only spend 15 minutes or less with patients
Seeing my doctor is seldom like coffee with a friend. How about a guy who does at least 6 patients an hour, and charged me $285. When you work for $8 an hour, you make that in a good week. Spend it in 10 minutes and come back in two weeks, so you are spending half your income on 20 minutes a month and all the doctor does is look at your infected toe.
This video had nothing to do with fixing the health care system.
well get a better job :)
Canada has a permanent solution. Show us the greenbacks first.
yup, like using a dictionary, seek answer. Council.
Trust me competition is a GREAT thing in the health service, try living in the UK with the NHS it's AWFUL. They have no worry about doing a decent job, they put 25% of the budget away to cover their own incompetence. So why do they need to perform good? No one here cares about how good a doctor is, just that they're a doctor.
@F K I don't THINK he's talking nonsense I KNOW he's talking nonsense. From Personal experience.
What a load of rubbish, the NHS is way better than US healthcare, it has full coverage, better outcomes, costs half as much and has a much lower incidence of lawsuits, on top of that Brits live, on average, 2 years longer and there are no bankruptcies caused by medical bills. The WHO puts the NHS in 18th place in the world rankings, the USA is 37th. The Commonwealth fund study of 2021 puts the UK at number 4, the USA at number 11, last of 11 developed countries, not only this the USA is ranked last in every category but one. It’s a disgraceful, unconscionable, disaster of a system that would be shameful in a developing country, never mind one of the richest countries in the world.
Medicare for All has market choices when it comes to providers.
bla bla bla bla bla bla bla
Was this a Ted talk, or a home talk taken on a Tedtalk stage?
We need to get robots do the job that can know all systems. maybe a person just can't do it
Martina RM * Every person is uniquely different. It takes a human being to understand a human being.
There is a 100% chance that the doctor will have the wrong diagnosis, for doctors remain stuck in a Newtonian concept of matter, and a deterministic physics that is out of sync with reality. If the right diagnosis is made it is by accident, or by intuition not by expertise, moreover, if the right diagnosis is made the wrong therapies will be offered, because of the faulty premise of the medical model of human reality. Today, the first step to dealing with reality is lifestyle medicine (Whole Foods, Plant-Baed -WFPB- nutrition), which means the focus is now shifted to the causes of the disease, not the symptoms (effects), along with it we need to shift towards the concept of the quantum doctor (see Amit Goswami's book The Quantum Doctor), and reframe the whole healthcare model in that mode, which is to realize that at all times the mind of the patient that is the healer and whatever healing modality is chosen merely provides the added subject matter expertise for the effectiveness of the healing. It is therefore also of great importance that the patient have understanding of the methodologies used and a healthy belief and trust in them. Guiding the choice for the appropriate modality is therefore the first job of the lifestyle physician.