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Question: How can a person be a better patient?

Atul Gawande: It's a good question, because I think it is -- there are two things about it. Number one is there's no straightforward recipe. But there are things that we recognize we can do. I think number one is to understand that making the system work well is something that we're only starting to grapple with. Medicine has been about parts; it's been about having a great drug, a great doctor. It has only in the last few years started to become about making all of that fit together as well as possible. And the most important role, I think, that patients play is, they're the only ones that see when things are falling through the cracks. You see one specialist and then another specialist, but they don't talk to each other, and what they're telling you doesn't make sense or fit together. A third of patients by the end of their life have 10 or more specialists in their care. And we're not very good at knitting all of that together.

And so I think the most important part the patient plays is not being passive about their part on the team. They are -- we're not great at drawing out the patient; we've wanted the patient to be passive and not so involved, just do what we say. But the more we have different people involved, what we tell people is contradictory. It doesn't always help them the way it should. And as we get our act together, I think what we're learning is, the patients play a key role.

Question: How can family members help?

Atul Gawande : One thing that I tell people is, if you have a sick family member, don't leave them alone in the hospital. Even when there are visiting hours where you're supposed to go home, I'll tell people, find any way you can to stay anyway, because when you're sick is the last moment when, as a patient, you're able to fend for yourself.

And the family member is often the person, as shifts change and different people come and go, who will be the ones to convey, you know, my dad actually seems sicker than he did yesterday. You'll be surprised about the extent to which just having those kinds of eyes and ears are missing with the slew of people coming and going. So I know it can be unnerving. It's sort of like when the effort to trap terrorists falls through, and the passenger has to be the one to tackle the terrorist trying to light the bomb on the plane. In a certain sense, for an extremely complex system of care to work well, we all have to be part of the equation. We in medicine have to be willing to hear from patients who have challenges. We sometimes have to be willing to push back and say, actually on that one, here's the reason why we're doing it this way. But it's becoming a group effort in order to get things right.

 

Doctor’s Orders: Don’t Stay...

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