One of our core values is continuous learning and remaining hungry for information that challenge our perspectives. This is what led us to start a reading list. In light of this, I picked our first two books to be Why We Revolt by Dr. Victor Montori and An Epidemic of Empathy in Healthcare by Dr. Thomas H. Lee. Both books focus on the need to deliver more careful and kinder healthcare while pointing out the significant changes that have taken place in the healthcare system.
I was instantly drawn to these books since Josh and I are tackling the problem of seroma, which is a post-surgical complication that most often develops once patients go home (multiple weeks from surgery). Our open conversations with many patients who experienced drains, the standard-of-care in mitigating the risk of seroma, suggested that these devices were far from delivering careful or kind healthcare. Partly because, they were created for use by healthcare professionals and they are not very easy to use by patients, especially at home. This topic of translation of devices from professional to lay people use has received increasingly more attention over the past 20 years as more and more healthcare occurs outside of a professional healthcare facility. For example, in a recent publication Dr. Kortum studied the usability of various medical devices by lay people and found most to be less usable than a microwave oven.
As I read Why We Revolt, I was especially drawn to a paragraph in chapter called Burden. Dr. Montori describes Minimally Disruptive Medicine in the following way. “Minimally disruptive care calls for programs that are easy to access and use, their content coherent, their care continuous and coordinated across all involved. It forbids the delegation of medical errands to patients and families and of considering them as unpaid extensions of the healthcare’s industrial workforce. Because so much care must be unavoidably completed by the patient, every effort should be made to free self-care from waste by enhancing its meaning, feasibility, and value to patient. Every portion of work ultimately assigned to the patient must be designed with the most overwhelmed patient in mind.”
As an endocrinologist, Dr. Montori focuses extensively on the burden placed on patients by unplanned clinic visits, complications with prescriptions, etc. While reading, I wondered about the issues that are specific to those who are recovering from surgeries at home, at times only 6 hours after a major surgery! Postoperative patients are certainly overwhelmed as they begin the heal at home. For example, on the day of a hip surgery, I arrived home with a prescription in my hand for two medical devices one for icing and one for moving the hip. Neither one of these were manageable by my mother or myself at the time. My husband had to set them up each time. These were devices used in professional facilities that were prescribed to me for home use. I think they helped in how fast I healed, but I cannot imagine them being operated by caregivers who are unlike my husband, mechanical engineer and a hands on person. This is only one example, but as more care takes place at home, there are many more examples of cumbersome, professional grade devices used at home by patients and their caregivers when they are truly overwhelmed.
In contrast, anywhere we turn, there is an increasing emphasis on patient experience, satisfaction, or patient reported outcomes. Some of the reimbursement being tied to such measures, many in the healthcare arena are focusing on how to assess them as well as in the creation of processes that allow better and kinder care. One piece that is less understood or appreciated is the role of engineers in making devices or solutions that are compassionate. For years, as a faculty member, I instructed my students to really understand the human side of the problem and encouraged them not to overlook the fact that engineering profession demands that we create solutions with a positive impact on the society. In other words, we need duplicate what is happening in healthcare in engineering and technology fields as well. Specifically, we need to bring humanity and care into our professional work. This is imperative in biomedical engineering where technologies are utilized to improve the health of those who are ill or not feeling well. As biomedical engineers, we have to listen to patients, surgeons, hospitals, and understand their pain. We should then be able to engineer a solution that is more meaningful and potentially more successful in addressing the unmet needs. I think we need an epidemic of empathy in engineering similar to the call made by Dr. Lee in his book.