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First recorded reflection on the healthcare cost and social support cuts was published in Pubmed central - Canadian Family Physician by G. L. Higgins in 1994 titled "The operation was successful, but the patient died". This mainly focused on rapid changes that were taking place in the social fabric of Canada with perceived fear of worsening in the future.
This is a appropriate phrase in core healthcare as well. There are two different scenarios that come to my mind in the context of above mentioned article.
Scenario 1: Life is saved but the person lives with disability
Scenario 2: Clinically maximum possible recovery is done, but the patient is not satisfied
These two are the most crucial aspects and has given a way to look at a disease or healthcare beyond just the clinical aspects. Although we are still way beyond the the developed world in incorporation of ICF model of healthcare, the tides are slowly changing towards patient centric approach from a physician centric approach.
Although there are extensive planning, strategies and monitoring that are being adopted to bring about this change, as simple as accommodation of perspectives can have a quicker progression towards the goal. What can be done in these two scenarios?
Scenario 1: A team of specialists discuss to balance the survival and functional benefits of a treatment and staggered approach in prioritizing different specialty involvement at different timepoints in care. This is not a guarantee that functionals will go back to how it was before, but to maximize the functions that may have been affected. Our aim is to achieve "The treatment was successful, and we have achieved maximum recovery".
Scenario 2: It is an absolute necessary that patient and care takers are informed about all the proceedings during the care. I personally believe that providing adequate information solves 50% of the problems. As a healthcare professional, it is also important to gain the confidence of the patient with right information. Understanding the patients and their family expectation and aligning it to maximum possible outcomes has to begin with round table dialogues which again points towards Inter/Multidisciplinary clinic discussion with adequate involvement of the patient or the decision makers. Focus of our effort is going to be "Treatment is successful, and the patient is aware and accepted the maximum possible outcome"
This is an important aspect of professional development as every healthcare professional is trained to carry out healthcare, but not all are aware of the ever changing dynamics of healthcare or can adopt to it. COVID-19 pandemic was a testing time and we have examples from every sector to have our learnings free of cost.
-Prasanna S. Hegde
References & Reading:
Higgins GL. The operation was successful, but the patient died. Reflections on health care costs and social support cuts. Can Fam Physician. 1994;40:421-428.
https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health
Functional goal writing using ICF https://www.asha.org/slp/icf/
Number of research articles on ICF model from 1952-2022 in Pubmed