Home Care: Heroes of Incremental Care

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Elizabeth E. Hogue, Esq.

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Home Care: Heroes of Incremental Care

An article entitled "Tell Me Where It Hurts" by Atul Gawande appeared in the
January 23, 2017, issue of The New Yorker. In the article Dr. Gawande, a
surgeon, makes this very important point: "We devote vast resources to
intensive, one-off procedures, while starving the kind of steady, intimate
care that often helps people more." Home care providers embody the
provision of "steady, intimate" solicitude and are the true heroes of
incremental care.

Dr. Gawande goes on to say:

Not long ago, I was talking to Asaf Bitton, a thirty-nine-old internist I
work with, about the contrast between his work and mine, and I made the
mistake of saying that I had more opportunities to make a clear difference
in people's lives. He was having none of it. Primary care, he countered,
is the medical profession that has the greatest over-all impact, including
lower mortality and better health, not to mention lower medical costs,.Asaf
tried to explain. "It's no one thing we do. It's all of it," he said,

Gawande points out that the relationships that are built through the
provision of incremental care make all the difference in the lives of
patients. It's the "commitment to seeing people over time" that ultimately
carries the day.

The heroes of incremental care, as Dr. Atul Gawande points out, must develop
patience in the face of their training that may have emphasized quick fixes.
They must also be able to tolerate the anxiety that goes along with taking
care of people who are sick, but not dangerously ill. Home care
practitioners must focus on patients' health over time.

Dr. Gawande concludes:

Success, therefore, is not about the episodic, momentary victories, though
they do play a role. It is about the longer view of incremental steps that
produce sustained progress. That... is what making a difference really
looks like. In fact, it is what making a difference looks like in a range
of endeavors.

Frequently, the only visible part of such incremental care is the cost.
There is often little certainty about the amount of money that will
ultimately be needed to show progress. Many are reluctant to address
problems until they are imminent and unavoidable, and it's difficult to
trust possible solutions that promise only longterm benefit. It's that
age-old problem of immediate gratification!

The key, says Dr. Gawande is to tap into at least four kinds of information
that matter to health and well-being: information about the state of
internal systems, the state of patients' living conditions, the state of
care received, and patients' patterns of behaviors. Surely, home care
providers regularly take all of these kinds of information into account.

As Dr. Gawande says, ".The incrementalists are overtaking the rescuers. But
the transformation has itself been incremental. So we're only just starting
to notice." In other words, hats off to home care providers who, rather
than going for the quick fix or rescue, stick with patients over the long
haul and ultimately make all the difference.

C2017 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the
advance written permission of the author.
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