We Need a Care Revolution: Victor Montori

In his book, “Why We Revolt,” Victor Montori decries the industrialization of healthcare.  We’ve become a healthcare factory, beholden to health systems motivated by profit. In particular, he laments the loss of the “care” aspect of healthcare.

Clinicians are under the clock to churn through patients.  Patients are tasked with doing work outside of the clinic. Patients are tasked with hours and hours of work to self manage, obtain and manage medications, track weights and fingersticks, not to mention scheduling visits and waiting around for the visit to start.

Now we have an app for that. For what, you ask? Well, for everything! Digital burden is real. Think about what we ask patients to do: charge your device, remember your password, 2 factor authentication, each interface is different, wait…where do you enter your fingersticks again?

Victor is an endocrinologist who often provides care for older patients with multiple chronic conditions, polypharmacy, and complex social situations.  He’s “one of us.”

Some might argue that these circumstances call for incremental change.  Not Victor.  He argues that we need a revolution. In particular, he argues that the revolution must come from patients to be successful.

On this podcast we discuss:

• Why do we need a revolution? What made him get to this point of arguing for a revolt?

• Why should the revolution be patient led, rather than clinician led? What role do clinicians have to play?

• What is minimally disruptive medicine (a term Victor coined with Carl May and Francis Mair in 2009)?

• How does shared decision making fit into the revolution?

• What’s the matter with guidelines? What’s the role of standardization?

• We suspect that most geriatrics and palliative care providers feel like they’ve escaped many of the issues Victor describes, trading less glamorous and remunerative work for more satisfying time spent caring for patients; focusing on what matters, goals of care, and attention to emotion and social well-being.  Are we deluding ourselves?

If you’d like to join the revolution, please check out Victor’s website, patientrevolution.org

And I believe this is the first Peter Gabriel song request! I think Peter Gabriel’s album So was the first cassette tape I purchased.  About time, 350+ podcasts in.  My son Kai turns this very non-guitar friendly song into an acoustic jam for the audio-only podcast version; you get my weaker attempt on YouTube :) 

Finally, a quick plug for the Sommer Lecture series in Portland OR.  Victor and I had a terrific time bonding at this year’s lecture series. While not strictly geriatrics and palliative care focused, the lectures seem targeted at a broad audience, with something for everyone.  And yes, I made them sing parody songs :)

-Alex Smith