Who Can Fix Healthcare?

Not doctors...Not policymakers...Not presidents, but 'YOU,' said Dr. Albert Mulley, Jr. just last month while speaking at TEDxDartmouth 2011. Mulley is the Director of the Dartmouth Center for Health Care Delivery Science and his research focuses on the support of patients and clinicians in their medical decision making roles.

By 'YOU,' it's clear that the good doctor means you, me, your spouse, your neighbor to name a few--all individuals with the power to proactively drive our health care. This is an idea that I've long advocated and one that resonates with me, and my colleagues on the NHDD team, to our core.

And, I'm pretty sure if you're an advocate of advance care planning (like us), you probably understand Mulley's rationale. However, if you're new to—or have simply, never given thought or credence to—the idea of taking charge of your healthcare through proactive medical decision making, you're probably looking around and thinking 'I'm not so sure about this; how could I possibly help fix healthcare in this country? Why is it my responsibility anyway?'

Well, here's your answer: 'Its the decisions that you make about your health and your healthcare that really drive the system,' Mulley said.

And, he's right! Let's examine Mulley's assertion a little. Healthcare can be extremely complex because we are all very different with varying values and personal standards about our health care, i.e. what we can and can't endure, what concessions or trade-offs in comfort or convenience we'd make in order to preserve our health versus our lifestyle (and the list goes on and on). Taking that into consideration, there can be no blanket fixes or solutions for any given medical condition. Care has to be handled on a case by case basis and as Mulley stressed, 'informed by both professional knowledge [or medical expertise; that of your doctors and other clinicians] and personal knowledge [YOUR expertise on your habits, lifestyle, religion, and most importantly, your 'revealed preferences'].' Care that does not take personal knowledge into account won't be efficient or effective because of how different every patient is from the last and from the next. And, you have to be willing and able to offer that personal knowledge in order to guide your physician's hand in treating you.

So now that you have an understanding of how you can accept personal responsibility for the healthcare system, you're probably thinking 'Well, now what? How do I take action to fix the healthcare system and contribute to my care?'

It's simple, really...be engaged in your own healthcare and that of your loved ones who aren't able or yet old enough to engage (likely, your children)—ask questions, express your preferences, spark conversations with your physicians and your family members about your care, do your research. Be ever-present in and take full stewardship over your health care goals and make them known to the people providing your care! As patients, we are responsible for participating in this way because 'if not here, now and us...where, when and who will fix healthcare?'

That was the open-ended question posed by Mulley as he closed his presentation, but I pose it to you as more of a call to action to take your first steps to help 'fix healthcare.' Here's what you can do today:

• If you haven't already, complete your advance directive.
• If you have, revisit and tweak it as often as your life circumstances change.
• When you have doctor's visits, be ready to express your personal goals of care with your physician and be prepared to question anything you don't understand.

Don't be shy, be proactive in your efforts to 'fix healthcare' in this country starting with your own personal care!

Photo from Dartmouth