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Saturday, October 17, 2015


5 stars out of 5

Before all else, I must thank the publisher (via NetGalley) for granting my request to read this book. But after I finished and began to write a review, the notion struck me that with no formal education or work experience in the health-care industry (unless you count an undergrad degree in psychology more than 30 years ago), for me to comment on anything written by such an accomplished professional as Dr. Lee probably qualifies as the height of chutzpah. So in my defense, I'll offer an explanation.

As a long-time (now retired) journalist, I've written about various facets of the business of health care many times. But more to the point here, for the past 10 years or so I've been a certified volunteer long-term care ombudsman for the state of Ohio, which is in the ongoing process of moving toward "person-centered care" - a relationship-based approach that honors and respects the voice of elders and those working most closely with them. Although this book doesn't address long-term care in particular, the concept of empathy certainly fits with the Buckeye State's efforts to better serve those who are in that system - and I wanted to learn more.

And learn I did. It helps that there's no "healthcare-speak" here; yes, there are many references to studies as well as graphs and several pages of source material, but the "meat" of the book comes through loud and clear. In essence, it outlines the need - and the opportunity - for health-care institutions to rethink their approach to caring for patients. The trend toward specialization has come at the expense of a holistic approach to patients, the author asserts; in fact, the more sophisticated the care, the greater the likelihood that patients will feel they're really not being cared for. Of course, the end result still counts a lot; but the goal shouldn't be simply to save lives, but also to see from the patients' eyes, assure (and reassure) them that the care they're getting is the best possible given their health circumstances and alleviate their suffering - and notably, the latter goes beyond physical pain. 

Competition, the author notes, is a major driver in the need to  shift the focus to understanding and meeting patients' needs. Patients now can choose their health-care providers, and even the loss of a few patients has the power to make or break a hospital or clinic. But while cost always will be a major factor in patients' decisions of which provider to choose, studies have found that other factors - like the belief that staff members are courteous and really care about them - rank higher in patients' minds than expected bugaboos like the length of wait to see the doctor and ease of getting in and out of the parking lot. 

Needless to say, this kind of shift in mind-set and actions isn't easy; running a heath-care facility in just about any setting is a business, complete with the seemingly impossible task of trying to satisfy a number of special-interest groups from patients to all levels of staff to family members to the CFO  (if you don't believe that, I invite you to follow a nursing home administrator around for a day or two) . But institutions that offer coordinated and empathic care that elicits trust from patients, the author argues, are better equipped to increase market share and retain good personnel. Several examples of excellence in health-care provider settings that are working are cited here, with explanations of how and why they're successful. 

One such institution is the Cleveland Clinic - about which I can speak from personal experience. When my husband needed rather complex cardiac surgery about five years ago, we opted to go there based on its stellar reputation in that field. Both of us were impressed with the facilities, the technology and afterward, the outcome - in our minds, the best possible given the circumstances. Oh yes, and one other thing: The friendly, caring attitude of everyone from the surgical staff to check-in clerks at the intake desks to red-jacketed greeters who stand ready to answer questions. Each time he's returned for routine maintenance since then, we've marveled at how people in such a huge, busy place can make us feel as if we matter. Because of that,  we're more than willing to make the hour-and-a-half drive instead of switching to cardiac care closer to home; exactly the point, I believe, that the author is making here: When care is empathic, the sum of the parts really is greater than the whole.

What needs to happen for institutions to make the shift is presented, including ways to measure effectiveness and reward excellence (no surprise to me, but financial incentives isn't the best approach). The author concludes with a 10-step directive, which includes making the meeting of patient needs as efficiently as possible the highest priority, with empathic, coordinated care as a core component. In short, I would recommend this book to anyone who is involved in health care, whether as a professional, a care-giver or someone like me who simply is interested in ways it can be improved.

An Epidemic of Empathy in Healthcare by Thomas H. Lee, M.D. (McGraw-Hill Education, November 2015); 224 pp.

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