Case Study Part IV: What Joan Really Needs From Her Healthcare

senior health and medications

Today, I’m going to share the fourth and final part of my case study about Joan, a 79 year old woman struggling to manage her many chronic conditions.

I created this case study for my upcoming ebook, because over the years I’ve noticed that different people can have very different perspectives on a single person’s health challenges.

So in the book, I cover the perspective of Joan herself, the perspective of Joan’s worried family caregiver, and then the viewpoint of Joan’s primary care provider, Dr. Miller.

But of course, there’s one more perspective that’s essential to consider, if you are developing tools to help people with their health. That’s the external “expert” analysis and perspective, which I share below.

When it comes to healthcare — or anything important — we can’t assume that front-line users know just what is best, and what’s most likely to help them achieve their goals. That’s why truly useful tools must facilitate “best care,” or at least better care. Here’s what that could look like for Joan.

What Joan Really Needs From Her Healthcare

Dr. Miller’s not a bad doctor. But he’s busy, he’s under pressure to meet quality measures, and he hasn’t been trained to modify healthcare for older adults.

Like many doctors, he’s pretty focused on Joan’s documented health diagnoses. But what Joan really needs is for someone to help her with her health problems. I’d list these as follows: [Read more…]

Case Study Part III: The PCP’s View on Joan’s Health

Doctor at workPeople often wonder why doctors aren’t more interested in apps for their patients, or in trying something new to help patients. After all, we expect doctors to care about their patients’ health.

Plus, we know that doctors are now being held more accountable for outcomes, because we’re moving towards “pay-for-value.”

I do believe that most doctors care about their patient’s health. But it’s not easy being a PCP, and there are lots of reasons that the average PCP has difficulty optimizing the health of a medically complex senior.

Here is part III of the case study I created for my upcoming ebook: the point of view of Joan’s PCP, Dr. Miller. As you read, consider

  • What’s the doctor focusing on when it comes to Joan’s health? How does that align with what Joan herself is most concerned about, and what her daughter is concerned about?
  • What kinds of tools or services might help the PCP with what he’s trying to do for Joan’s health?

And for extra credit: what’s he overlooking that someone applying geriatrics — the art & science of modifying healthcare so it’s a better fit for older adults — probably would address? (Hint: it’s related to Joan’s vitals.)

Joan’s Health Story (According to Her Doctor)

[Read more…]

Case Study Part II: Joan’s Daughter’s View on Joan’s Health

In my upcoming ebook about better digital health tools for aging adults, I share a case study — an older woman named Joan — and I write about her struggle to manage her health from three perspectives: Joan herself, her concerned daughter, and her busy primary care provider.

Joan has more chronic conditions than most seniors — eight diagnoses, plus she’s had falls recently — but they are a fairly common combination in people who smoked and were overweight in middle age.

In this post, I share part II of the case study: the perspective of Joan’s daughter Susie, who is understandably worried about her mother’s health and wellbeing. (See Part I of the case study for Joan’s perspective, plus a list of her conditions and medications.)

As you read this, consider the following:

  • Do you know many people worried about the health of their older parents?
  • What kinds of technologies, tools, and services have you come across that might help Susie and Joan?

Joan’s Health Story (According to Her Family Caregiver)

Worried family caregiverSusie is worried about her mother almost all the time. [Read more…]

Case Study: The Story of Joan & Her Health

Did you know: in 2010, 46% of fee-for-service Medicare spending went to those 14% of beneficiaries who had six or more chronic conditions. (See Fig 3.2 of the 2012 Medicare Chronic Conditions Chartbook.)

You might think those are unusually sick seniors. But when I practiced primary care internal medicine, I saw people with 6+ conditions all the time. As you can imagine, they tend to see doctors a lot. (That data is in Figure 2.4 of the chartbook.)

It’s actually not that hard to end up with several chronic conditions by age 65: a history of smoking and being overweight in middle age will easily bring on 6+ chronic conditions later in life. And many of those seniors don’t look that sick or disabled.

But they struggle with their symptoms, and they especially can struggle with an overwhelming amount of “self-healthcare” to manage.

If there’s anyone who would benefit from digital health technology, it’s them. They need help with their health. Their primary care providers need help helping them. Their adult children are worrying. Oh and, we want to help them in order to minimize ED visits and hospitalizations, which are distressing for seniors and expensive for all of us.

Unfortunately, over the past three years I’ve found very little that seems usable and useful for these seniors with multiple chronic conditions.

So as part of my upcoming ebook about better digital health for seniors, I’ve written a little story. It illustrates the situation of Joan, an older woman struggling with multiple conditions. I’ve even included her medication list.

As you read this, consider the following:

  • If you’ve developed or are using a digital health app or service: do you think it will work for Joan?
  • More importantly: what do you think would be most beneficial to Joan right now, to help her with her health?

Joan’s Health Story (According to Joan)

Joan, aged 79, is more than a little tired of dealing with her health.

She didn’t always have health problems. She had a career and raised her kids and earned a good pension that supports her now that she’s retired. She lost her husband to a heart attack years ago, but she’d be doing fine on her own if she didn’t have to keep going to the doctor all the time.Maybe she hadn’t taken the best care of herself, but who knew the difference? Everyone smoked. And she quit five years ago anyway. She’s maybe a little overweight, all right, but you try having three kids and see if you stay slim.

She puts on a brave face but she feels a crippling guilt sometimes for not looking after her health. Maybe it’s her fault that she has hypertension now, and high cholesterol. She knows her diabetes and the osteoarthritis in her knees can probably be traced back to her weight, and her doctor’s told her that smoking caused the chronic obstructive pulmonary disease, and maybe the atrial fibrillation too.

[Read more…]

7 Types of Help People Want from Healthcare

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.

Similarly, I think it’s useful to sketch out the types of help that people seek from the healthcare system. So far I’ve come up with seven.

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.

This is the underlying reason that people want help with their health.
(What is health? See my practical definition here, and yes I’m still hoping for feedback on it!)

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

[Read more…]