Genomic Medicine Demands a Long Term Framework

as soap-opera hero, from “Dr. Kildare,” “Ben Casey,” and “Marcus Welby, M.D.” to “ER” and “Chicago Hope,” bolsters and repeats the image of doctor as semi-divine keeper of information and judgment. Most students in medical-school boot camp, even now, are trained in a crisis-oriented intensive model that gives little or no place to the arc of a lifetime, the relationship with a whole person, the involvement of a whole team.

What About You?

How do you start to create it yourself? Rather than wait for it to be created? By holding up a mirror to yourself. As a doctor, a patient, a nurse, a family member, when it comes to health and health care, who do I want to see in the mirror?

We already know that you have taken one step: You’re here on HealthCentral.com. That means automatically that you are more curious, more interested, more ready than most to create your own future.

As a patient, this is just what is required: Educate yourself, ask questions, be a squeaky wheel, demand that your doctor and other clinicians build that kind of active, involved relationship with you.

If you are a doctor, give patients the space to be involved and curious. Carve out the time and energy to have a relationship with each patient. Don’t take the role of medical judgment until it is thrust on you. Invite collaboration from nurses and other colleagues. Make use of their judgment and observations.

As kin of a patient, be open with information and support. Be a listener. Be assertive, if necessary, in running interference with the system for an elderly or sick relative. Get involved and stay involved.

As a nurse, build collaboration with fellow nurses and with any physician that provides an opening — and let the others know that is what you expect.

As an executive at an HMO or insurance provider, take a long look at the true costs of interfering in medical decisions, and of paying only for acute interventions, rather than prevention, education, and long-term collaborative management. Take a new look at the policies and orientation of organizations with a much lower “churn rate” (percentage of customers who don’t re-up each year) than yours, such as Kaiser and Group Health of Puget Sound.

Policy changes, legislation, and new, creative ways of doing business all will make a difference. But none will have the revolutionary force of changed attitudes and new behaviors. Become the person that you would like to have on your health care team.

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