Health — A social concept - The Sequel
In the last blog, we discussed the impact technology has on participatory medicine and ended with the idea that what was lacking to really bring health 2.0 into full force were the networks of networks. Alongside concerns around technology expressed in the end session of the conference, were concerns about people. As Clay Shirky writes in his article on health information technology and magical thinking, “humans are the trust networks, not technology… when it comes to health, patient centric medicine is not just about ‘me, me, me’ any more….it is about me and everyone I am talking to.”
In a similar vein, Enda Madden in her blog on outcomes and health wrote this week that “…one of the main motivations of FIT (Feedback Informed Treatment) in our opinion is that very often the patient is an expert in their particular condition. This is especially true in the case of people suffering from long term chronic illness.” No one knows their body or experience quite like the person there. Yet the professionalization of medicine and the medicalization of health/illness has placed distance and strangeness onto our bodies and our intuitive knowledge of dis-ease. Now we trust the trained professional. Yet the informal conversations that govern and found trust networks are between “people like us”. This can be especially true when patients are attempting to self manage chronic illness and when they are providing progress reports in treatment with their healthcare professionals. Few physicians would contest that this knowledge exists but the ways it interacts with professional medical knowledge can prove problematic for overall health and the care of others.
The problem, according to Shirky is that we underestimate collaboration. Collaboration between those in need of care and those who provide it, collaboration with peers, collaboration with families and with communities. It’s like rugged individualism on crack. We have forgotten our deeper interconnectedness with each other and our collective health. That’s why people like David Kibbe, MD who also spoke in the closing session of the health 2.0 conference ask us to be critical of health 2.0 ventures and technologies in that they may not actually be changing health care but just automating or putting a band-aid on the same inefficiencies that plague everyone in the present system. He urges us instead to talk to our own personal doctors about what we want and see what we can make work together.
This framing of the clinical relationship enables us to provide the environment necessary for web 2.0 technologies to facilitate a different kind of health care. For those of us involved in spine care, we might remember a recent editorial in SpineLine where the President of NASS, Thomas Faciszewski, MD, writes on “defining our worth” and quotes Adam Smith, the economist as saying “How selfish soever man may be supposed, there are evidently some principles in his nature, which interest him in the fortunes of others, and render their happiness necessary to him, though he derives nothing from it, except the pleasure of seeing it.” At the heart of health, there is the desire to alleviate an other’s suffering.
Health as a social concept, asks us to remember the people, why they come to us, who we are with them and how we all are together. In this way, the “value” or “worth” of any physician, spine or otherwise, lies in their presence in that clinical interaction. As Dr Faciszewski puts it, “we must consider all of our patients and the treatment options available to them in the context of the society in which they—and we—exist. We must consider the impact of each patient’s treatment on that society.”
Consider. Communicate. Collaborate. Co-create.
With a shout out to H G Rules and Liz Bernunzio for their wonderful images!
Good things happen when we connect!
Kirsten Broadfoot
Tags: Clay Shirky, clinical interaction, clinical relationship, clinical research, clinical trials, co-create, collaboration, FIT, health, health 2.0, health care outcomes, health outcomes, NASS, NASS 2008, network of trust, participatory medicine, patient centric medicine, spine care, spine care center, SpineLine, technology, the collaboration, trust model, trust networks, web 2.0, web 2.0 health
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October 30th, 2008 at 4:18 pm
Interesting post Kirsten… I also think the development of best practices and sharing those is paramount. But the key is developing the best practices. Collaboration is a process that includes vetting the best ideas. In other words, collaboration is KEY!