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:
Symptoms
- Shortness of breath
- Pain, especially in her knees
- Falls
- Depressed mood and occasional trouble with motivation
Problems managing her chronic conditions
- Difficulty maintaining the right diet for diabetes
- Difficulty checking blood sugar daily
- Difficulty exercising regularly
- Difficulty losing weight
- Difficulty taking all her prescription medications correctly and regularly
- Difficulty remembering which over-the-counter medications she should be avoiding in order to protect her kidney function.
Problems participating in her life
- Struggling to see friends and do other activities
Problems with treatment burden
- Feeling burdened and overwhelmed by her health problems, and by everything she has been told to do for her health.
Problems for family caregivers
- Susie’s worried about her mother
As you can see, many of Joan’s problems can’t be neatly assigned to individual diseases. In fact, some of her problems are due to interactions between her diseases, as well as difficulty keeping up with everything she’s supposed to do.
You don’t have to be an exceptional doctor to think of a patient’s health in terms of problems along with diagnoses. Like most primary care doctors, Dr. Miller knew that to help Joan with her shortness of breath, he’d need to sort out whether the recent episodes were due to her atrial fibrillation causing high heart rate, versus her COPD getting worse. What is more exceptional, among doctors, is
- Focusing on whatever problem is most pressing to the patient and family. Miller is preoccupied with having the numbers for the chronic diseases on track. Meanwhile, Joan’s primary concerns are feeling crummy and being overwhelmed.
- Having a sense of empathy for the overwhelming burden that chronic illness care entails, especially when a patient is older and has multiple conditions.
- Using a minimally disruptive medicine approach, which involves minimizing treatment burden and helping patients improve their capacity to manage chronic illness.
- Knowledge of how to effectively manage common senior health problems, such as falls. Miller reflexively thinks Joan’s low blood pressure is okay. But a clinician applying geriatrics knowledge would worry that her falls might be related to overtreatment of hypertension or diabetes.
In other words, many doctors aren’t helping patients with what matters most when it comes to their health. (And we’re not even going into what is ideal care for each of Joan’s chronic conditions, and how to combine all the ideal care recommendations for her eight chronic conditions.)
The Dr. Millers of our country would like to do better, but they are very busy, very stressed, and being pressured to focus on quality metrics. So Dr. Miller and Joan and Susie could definitely use your help. They need your technology to help them address the many things that are going on with Joan’s health. They need this so that their daily lives can feel better, and also so that Joan can avoid disability and health complications, which has financial implications for all of us.
This case study has been excerpted from my upcoming ebook, Better Digital Health For Aging: A Case Study & Practical Tips for Entrepreneurs, Designers & Innovators. Sign up for GeriTech’s email list to be notified when it becomes available in October 2015.
