- Geoff Bennett:Recent studies report that two-thirds of American physicians today report feeling burned out, something only aggravated by the pandemic.One of the consequences, a decline in the quality of care for patients, who find it increasingly difficult to navigate the health care system.Fred de Sam Lazaro looks into one effort to improve on both scores.
- Liel Pink, Patient:Because it is so important, I am here to say that life gets better.
- Fred de Sam Lazaro:From her everyday musings…
- Liel Pink:I try to be of the mind-set that man is inherently good
- Fred de Sam Lazaro:… to humorous glimpses of her health care journey…
- Liel Pink:They need to make cuter medical gowns.
- Fred de Sam Lazaro:… Liel Pink’s quirky, optimistic social media posts resonated with hundreds of thousands of her generation who became her followers.
- Liel Pink:So, I am going to join my Zoom class looking like this.
- Fred de Sam Lazaro:She graduated last year at 21, and at the top of her class at Hofstra University with a degree in community health.
- Man:Congratulations, Liel.
- Fred de Sam Lazaro:And with multiple awards that included a virtual ceremony just for her, one she took leave from a hospice bed to attend.(APPLAUSE)
- Fred de Sam Lazaro:Weeks later, Liel Pink would die from multiple complications of a rare mitochondrial disorder she had struggled with through much of her three years in college.Tamar Fenton, Mother of Liel Pink: We don’t know if she could have survived it if they had caught it early, but the process and the journey that she went through 100 percent should have been different.You can really see the difference in what happened to her.
- Fred de Sam Lazaro:Liel’s parents say their daughter was a poster case for what’s wrong with America’s health care system, enduring an uncoordinated journey from one provider to the next.
- Tamar Fenton:Gastroenterology, cardiology, endocrinology.
- Fred de Sam Lazaro:Many discounted her symptoms. Each addressed just the issue within their specific expertise.
- Tamar Fenton:A G.I. perspective, a neurologic perspective, a cardiac perspective. And it’s almost impossible to get doctors to talk to each other.
- Fred de Sam Lazaro:Liel was prescribed close to 200 different medications, a regimen she tracked meticulously. She created a 28-page spreadsheet with all the lab tests she’d had.
- Tamar Fenton:She would have to tell doctors, “You can’t prescribe me that, and here are the reasons.”David Pink, Father of Liel Pink: She was assertive. And to have this 20- and 21-year-old telling the doc, “You can’t do this,” they didn’t appreciate it.
- Fred de Sam Lazaro:They say Liel struggled to convince doctors that her various pain symptoms were real and that treatments she was being prescribed were not working.(SINGING)
- Fred de Sam Lazaro:Instead, her parents say, early in her health care ordeal, Liel’s symptoms were attributed to mental health, the start of what her mother calls diagnostic momentum.
- Tamar Fenton:This idea that, once a doctor says what he or she thinks it is, every other doctor is going to look at that as the starting point, and it’s very hard to break from that.And she did have a few really exceptional doctors who said things like: “Medical science has not caught up to what is happening in your body.”That was music to our ears.
- Fred de Sam Lazaro:Liel’s parents don’t name names. They have no plans to sue any provider or hospital system. Tamar Fenton and David Pink say they just want to use their daughter’s experience to improve a health care system which they say is uncoordinated and ill-equipped to deal with complicated cases like Liel’s.They are part of an initiative called The Patient Revolution begun by Mayo Clinic endocrinologist Victor Montori.
- Dr. Victor Montori, Mayo Clinic:This form of health care is not humanly sustainable for the patients and clinicians that are showing up to care within it. So, we need to go to the root cause of that. The root cause of that is the industrialization of health care.
- Fred de Sam Lazaro:Dr. Montori says the system prioritizes industrial efficiency, as much as actual care, rewarding providers for volume, as much as quality.
- Dr. Victor Montori:As people get processed through, they become a bit of a blur. We don’t see them in all their biology and their backstory. Our response then is to their common characteristics.So here’s the treatment that we give people with diabetes. Here’s the treatment that we give people with hypertension. And the job is not to care for people like you. The job is to care for you.
- Fred de Sam Lazaro:And he says you, the patient, are often far less savvy than Liel Pink and her parents in navigating the system. He says the costliest outcomes are borne by the neediest patients and under-resourced providers.
- Dr. Victor Montori:It creates a lot of work for people that might even leave their care and stop taking their medicine, stop showing up for appointments, because it’s just not designed for them.
- Dr. Mark Linzer, Hennepin Healthcare:We had patients who were escaping the care that we wanted to give.
- Fred de Sam Lazaro:Dr. Mark Linzer is one of 100 so-called Patient Revolution fellows across the world. In 2010, when he joined Hennepin Healthcare, a Minneapolis system that serves some of the city’s most marginalized people, Linzer says there was high staff turnover and, for patients, long wait times for, at best, incomplete care.
- Dr. Mark Linzer:They were in the emergency room once or twice a week. They were hospitalized every month year in, year out. And we wanted a better way for them.
- MAN:Everything seems like stimulus response.
- Fred de Sam Lazaro:Today, that better way is in full swing in the form of what’s called the Coordinated Care Clinic, bringing together expertise to treat the whole patient, not just the immediate medical need.Doctors, social workers, psychologists, chemical dependency specialists, and others meet regularly. They’re also on speed dial with housing or finance officials, if needed.Lyle Thibodeaux first came seeking treatment for alcohol abuse.
- Lyle Thibodeaux, Patient:I had six family members pass on me. I had a really good friend get killed. And that’s one of the things that drove me to drink.
- Fred de Sam Lazaro:He’s been sober for six years and loves his job as a restaurant server. The clinic staff, he says, has become like a second family.
- Lyle Thibodeaux:They’re by my side all the time.
- Betsy Lidster, Patient:I have had a headache, though, for months now. I am a headache.(LAUGHTER)
- Fred de Sam Lazaro:Betsy Lidster’s medical challenges have been complicated by homelessness and addiction problems that date back three decades to opioids she was prescribed after a severe car accident.The clinic has been a one-stop shop to help stabilize her life. It helped find her shelter for a start. And the team keeps regular tabs on her in and out of clinic appointments like this one with Dr. Brian Grahan.
- Betsy Lidster:Dr. Grahan has been incredible. He keeps me laughing. The social worker here calls me once every two weeks to check in on me.
- Fred de Sam Lazaro:The results? Hospitalization and emergency room use by Coordinated Care Clinic patients have declined significantly, saving this public safety net health system tens of millions of dollars over the years. And early job satisfaction surveys show marked improvement.
- Dr. Brian Grahan, Hennepin Healthcare:I probably spend more time per patient outside of clinic hours in this clinic than any other clinic I have ever been in. It’s not just producing health care, but it’s trying to produce health. And I think it’s that health production that I feel it’s a big value for me.
- Fred de Sam Lazaro:It’s one small example of many attempts to produce health with unhurried, holistic care, says the Patient Revolution’s Dr. Montori.But he’s realistic about how quickly change can come in a complex health care system, an industry, as he puts it, that accounts for about a fifth of the United States’ gross domestic product.
- Dr. Victor Montori:It will be almost like building a cathedral. Lay out the first — the first set of stones, and perhaps they never get to see the full thing built up. But they hope that, when anybody anywhere in the world becomes sick, and goes to the health care system, that the response will be careful and that it will be kind.
- Tamar Fenton:I think were trying to pick up where she would have taken this fight to fix health care, because that was her passion.
- Liel Pink:I am now in a wheelchair with my mother pushing me.
- Fred de Sam Lazaro:Tamar Fenton and David Pink say they’re committed to changing the rules for patients like their daughter. She wrote toward the end: “Children aren’t supposed to die before their parents, but then I was never one to follow the rules.”For the “PBS NewsHour,” I’m Fred de Sam Lazaro in St. Louis Park, Minnesota.
- Geoff Bennett:Fred’s reporting is a partnership with the Under-Told Stories Project at the University of St. Thomas in Minnesota.
Returning Care to Healthcare
A better way for providers and patients
Two-thirds of American physicians report feeling burned out, something only aggravated by the pandemic. One of the consequences is a decline in the quality of care for patients, who find it increasingly difficult to navigate the healthcare system. In this report we look into one effort to improve on both scores.