What do people want from their health care, and their medical care?
In my last post I shared a rough taxonomy of patient types, based on stage of life and type of chronic health problems.
But before I share them, let’s step back and consider the big picture of health care.
What’s the point of health care and our healthcare system?
The overarching purpose of health care, and the overall thing people want from healthcare, is:
To optimize the ability to participate in life, today and in the future.
Just what it takes help optimize a person’s abilities depends on the details of their health situation. For instance, for a person who has recently suffered a stroke, it might be things like speech therapy and physical therapy to optimize function, adaptive equipment and home modifications to facilitate getting around safely, treatment of post-stroke depression, and medical management to reduce the risk of a future stroke.
7 ways the healthcare system helps people with their health
In terms of the ways one might optimize people’s health, I see people requesting or expecting the following seven types of help from the healthcare system:
- Symptom and distress relief. People want help when they are suffering or bothered by feeling unwell. Symptoms may be brought on by a known chronic condition (such as shortness of breath due to heart failure or COPD), or they may be new and in need of diagnosis as well as management. Although sometimes people need clinicians to directly provide a form of symptom relief, via a prescription or medical intervention, often the clinician’s role is to help patients develop a plan for managing the symptom outside the clinic’s walls.
- Diagnosis and management of acute health problems. When people experience a change in health, they want help correcting the new problem. Most people also want an explanation for what has caused the problem.
- Prevention and/or delay of disease progression and complications. For people diagnosed with a chronic condition, they generally want help in preventing or delaying worsening of the condition. They also often want to avoid later complications, especially if they’ve learned about possible complications.
- Improvement of function. When people have been impaired by injury, illness, or have otherwise experienced a disability, they often come to healthcare providers for help in restoring or improving function (meaning one’s ability to do one’s usual tasks). Sometimes this optimizing of function is often done by clinicians specialized in therapy and rehabilitation, such as physical therapy, occupational therapy, and speech therapy. Behavioral therapies such as cognitive-behavioral therapy are also meant to improve function.
- Prevention of new health problems or chronic conditions. This can be called prevention, wellness, health maintenance, or even “healthy aging.” People tend to be especially interested in avoiding health problems to which they’ve had some exposure, via health education, media coverage, or observation of people they know. Conditions which I see many people anxious to avoid include cancer, heart disease, and Alzheimer’s.
- Screening to catch new diseases early. The classic form of this service is cancer screening, especially for breast and colon cancer, but a variety of other conditions can also be screened for. There can be some overlap between screening (which technically means the person hasn’t developed overt symptoms yet) and early diagnosis, which means investigating symptoms and establishing a diagnosis earlier than is often done. New technologies are promising to give people the ability to perform screening and early diagnosis on their own, with less involvement of healthcare professionals.
- Explanations and guidance. Although much health and medical information is now relatively easy for the public to access, people still often want to get explanations and guidance from healthcare professionals. Historically clinicians provided health education in a very didactic format (“Here’s what to know, here’s what to do”); today we are moving towards more of a coaching approach, in which clinicians work collaboratively with patients and attempt to better understand the patient’s situation before developing a management plan together.
Obviously, the healthcare of a single chronic condition often spans several of these types of help.
For instance, a person with stage III chronic obstructive pulmonary disease (COPD) will benefit from relief from shortness of breath, extra help during an exacerbation or other acute health problem, assistance in stopping smoking and otherwise taking action to slow disease progression, and pulmonary rehabilitation therapy to optimize strength and breathing technique. Such a patient will also benefit from age/prognosis appropriate health screenings and prevention activities.
Although people seek the above seven types of help from the healthcare system, they also pursue them outside the professional healthcare system. They may seek these services by:
- Searching online for information
- Interacting with peer communities online or in support groups
- Seeking help from health professionals whose services are not usually covered by medical insurance
- Using consumer health and wellness products and services
- Taking “self health care” actions, which I define as anything a person does with the explicit purpose of improving or maintaining health.
Why improving healthcare is so complicated
So many different types of patients. So many different types of healthcare help needed. So many additional influences on health and behavior.
Even if you stripped out the antics of powerful incumbents protecting their financial revenue, you’d be left with a lot of complexity to manage and improve.
We must continue our efforts, of course. But when we decide we’re going to improve healthcare, it might be good to think about how that might work for different types of patients, and for providers who are expected to provide lots of types of help.