Humane Health Care Outcomes By Creating Therapeutic Alliances

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  1. The Good Doctor

    The Good Doctor Golden Member

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    An excerpt from Humanizing Healthcare: Hardwire Humanity into the Future of Health.

    Now that humanizing health care has tangible meaning, let’s see how people experience it when executed. Having committed to continuously humanizing health care, we need a collective vision for it. We defined the consumer and his or her NSN, referring to them together as the home team in engaging the individual patient-consumers and their natural support system characteristic of humanizing health care.

    After years of work, my colleagues and I concluded that the foundation of continuously humanizing health care is the creation of therapeutic alliances. A therapeutic alliance is a bond between the consumer and the care team based on a mutual sense of caring, a core goal toward health optimization, and trust. It is a relationship that is developed and longitudinally nurtured. As I shared earlier, among many positive benefits to therapeutic alliances is how injecting compassion and empathy into the science of medicine creates better outcomes, decreases costs, and humanizes the experience for everyone — consumers and their NSN and, just as important, clinicians.

    [​IMG]

    Creating therapeutic alliances involves:
    • Integrating the clinical team with the home team
    • Sharing engaging and actionable information with consumers and designees of their natural support network
    • Exploring how individual consumers may be drawing on multiple modalities in their journey toward healthfulness
    Only with therapeutic alliances can we achieve a comprehensive community of care with stakeholders concerned about an individual (see figure above). Including the natural support network is a critical nuance of the new way we must consider the health care consumer, not as individual patients.

    Too often in health care, clinicians think of someone as an organ or chronic condition and call him or her a patient rather than considering the person as an individual with a broad network of supporters. And how can this group of stakeholders from the health industry and the individual’s natural support network share information and communicate and coordinate together? They can use digital technology to coordinate their efforts, with data and other information shared when and how needed with designees.

    This information would be in an engaging format allowing the home team to take appropriate action based on immediate needs. The home team can also ask questions on the next best action and gain advice specific to that consumer. The clinical team would need to be open to how individual consumers, influenced by specific cultures, draw on multiple approaches in their journey toward healthfulness.

    Let’s explore this last item — the clinical team’s readiness to learn about and understand different healing modalities. As mentioned previously, healthfulness is a comprehensive approach to an individual’s life. Health care providers need to consider how individual consumers are integrating their care instructions as well as other modalities for problems such as nonacute ailments, stress, and other maladies. These include a combination of:
    • Conventional medicine. Following the advice of other mainstream allopathic and osteopathic physicians
    • Lifestyle. diet, exercise, and stress management
    • Behavioral health. Emotional, psychological, psychiatric
    • Supplements. What vitamins, herbs, and other supplements are they consuming?
    • Complementary health. Modalities that consumers follow for cultural or exploratory reasons, such as acupuncture, homeopathy, Reiki, and massage
    • Home remedies
    Working in an emergency department in rural Florida, I learned of home remedies used in the South by families with limited access to care. Listening to a nurse triage an elderly man complaining of “pons and risings,” a colloquialism for infections and abscesses, I learned that some of his side effects were due to his home remedy of bleach and gasoline, two low-cost ways people in that region addressed skin infection. Without the openness to exploring home remedies, we may not have been able to quickly understand how to address this man’s health situation.

    Consumers often withhold information about nonallopathic modalities lest they be chastised by their Western-trained doctor. By being open to other therapeutics, as this nurse demonstrated, providers can build trust with consumers.

    The entire clinical team also gets a complete understanding of the individual’s overall care plan. I’ve had colleagues share that they do not integrate complementary medicine of which they lack knowledge or heard lack scientific basis.

    Most doctors, of course, will not be experts on all therapies chosen by a consumer and may not understand how different modalities interact. Yet providers must still inquire about whether consumers are using other modalities — because they are — and how these relate to their cultural beliefs on healing and wellness. For a therapeutic alliance to develop, consumers must trust their clinical team and know that their preferences are considered in forming a care plan.

    This point is worth emphasizing. Let’s double down on the consumerization trend and consider the health care consumer to be the individual at the center of the therapeutic alliance. In the past, doctors were the central decision-makers and organizers of care, and they often treated patients with little regard for different cultures and other preferences.

    In fully-humanized health care, I envision patients as clients, with doctors as part of the health care team in a role more akin to expert consultants and skilled proceduralists. The consumer is empowered in the network to drive his or her own health — taking the central role rather than the physician.

    By continuously humanizing health care and creating therapeutic alliances, we gain one more benefit. We enlist the efforts of the client’s natural support network, a free army of caregivers to reduce the load on our overburdened health care system. But to be effective, the support network will need engaging and actionable information. Together with providers, they will help individuals integrate multiple modalities in their journey toward healthfulness.

    Therapeutic alliances not only would reduce costs by sharing information with people in a way that encourages them to take more responsibility for their own health, but they would also reduce the dehumanization rampant in health care today.

    Humanizing health care outcomes = creating therapeutic alliances

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