So, this is a thing…
we paradoxically add more and more to the work of being a patient when the patient is least able to manage that work.
There is a lot of discussion about the “workload” of being a patient with chronic illness, and the “capacity” to manage that workload. We add to the workload with medicines, dietary restrictions, multiple specialty visits. The capacity to deal with that is diminished by the illness itself so we paradoxically add more and more to the work of being a patient when the patient is least able to manage that work.
Minimally disruptive care tries to match workload and capacity. There are four principles at work (from BMJ 2009)
- Establish the weight of burden: ideally with some set of tools or metrics that could help us define and follow this.
- coordinate care: rather than reimbursement targeted to “one size fits all” HbA1c or LDL targets, actually use incentives to prioritize care and help patients navigate the health system
- Acknowledge comorbidity in clinical evidence: develop guidelines that deal explicitly with managing multiple chronic conditions. Help us figure out what to prioritize for the typical veteran with DM, CAD, and COPD.
- Prioritize from the patient perspective: the patient should be equally invested in which conditions to go after next, based on their own goals and the treatment burden. We do this already when we hold off on starting insulin (a treatment with a relatively high workload) and focus on blood pressure instead.
I came across this info via twitter and this you tube video (also below), and I like the concept. Some have called it Geriatrics for the Young, or Palliative care for those far from the end of life. Read more here or here.
What do you think?