One Size Fits None

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One Size Fits None

By Dr. Kaylan Baban

There is a network of luxury resorts across the United States that is spoken of in reverential tones. Calming, re-energizing, detoxifying, one has the impression from its devotees of a fountain of youth.

How does this mystical oasis produce such bliss? Amongst the tarot card readings and whey powder smoothies, they offer such transformative experiences as: Personalized physicals! Diagnostic tests! Physical therapy!

It never occurred to me that this is might be what my former roommate was doing on family vacations, until I attended a revelatory and thought-provoking NYC Health Business Leaders event on May 7th with the authors of Tech Tonics:  Dr. David Shaywitz and Ms. Lisa Suennen. Ms. Suennen (aka @VentureValkyrie) deserves credit for opening my eyes on this particular point, by sharing her own brush with medical spas in a reading from the book. She poses the question: Why will people drive hours and pay thousands of out-of-pocket dollars for the privilege of having their lungs percussed, yet begrudge a co-pay for their local in-network physician? In this question, she wisely suggests, lies the answer to true patient engagement.

At first, the difference seems to be a want that originates internally, versus the perception of an externally-imposed requirement. One is eagerly sought-after, the other resented. This perspective is a bit depressing as a medical professional. Try as I might, I haven’t been able in the past week to make anyone excited and fulfilled by, say, refilling their blood pressure medication. It may be critical to helping patients achieve their goals of health, wellness, optimized quality of life and extra years with loved ones, but they most likely don’t notice any immediate benefit from it, and the pill just serves as a daily reminder of illness and mortality. No one wants to have to take medicines, but we, their doctors, are telling them they not only have to take it – thereby accepting their own mortal fragility – they have to pay for it, too. As Dr. Shaywitz summarized investors’ positions with reference to misguided entrepreneurs, but could have applied to a patient’s perspective on physicians with equal relevance here: Don’t make your solution my problem.

But there’s much more to this conundrum than the dichotomy of desire versus requirement. Take another look at the first in the list of services above: personalized physical exams. I would be hard-pressed to tell you what exactly distinguishes such an exam in practice, but the nomenclature speaks volumes. Pesonalized. This one little word, I think, is the root of everything that frustrates patients about modern healthcare and forces them to seek wellness elsewhere.

I’m not suggesting that patient-facing products and services must be extravagantly luxurious or expensive to be personalized. There will always be a role for resort spas, and a level of service they can provide that is well-beyond the scope of any medical center (at the end of a long week of desk lunches, little sleep, and a portable office on my shoulder, I can certainly hear them calling), but patients are engaged by the care they offer, and we should strive to learn from their model. Personalized means, whenever possible:

  • Understanding our patient’s health and wellness goals, not our goals for them.
  • Addressing the patient’s priorities, not our own.
  • Tailoring treatment options to the individual, rather than prescribing a single remedy that we “know” is best
  • Considering the whole person, not just the condition or organ system that brought them in.

It is so ingrained in our professional culture that I think it bears repeating: Our role as physicians is not to make our solutions our patients’ problem. This will only create a put-upon patient who resents our time and fee. Our role is to understand their personal wellness goals, and to provide responsible, informed guidance to help them achieve it. Often the solution we offer may ultimately be the same, but reframing it in the context of the individual in front of us can make all the difference.

It should be noted that the bullet point lessons above have equal relevance to the entrepreneur. Shaywitz and Suennen draw on long experience with solutions that nobody wants, and trace the roots of that bubble-bursting phenomenon back to the same cause: Failure to consider the perspective of the target market, and to prioritize solutions that address their particular needs, desires, context, and limitations. In both cases, what distinguishes a satisfied, engaged, dare I say loyal consumer is not the talent, intelligence or creativity of the service provider, be they clinician or entrepreneur. These qualities are critical, but not enough.

The key, the authors suggest, is to be thoughtful in our approach, to carefully consider our audience, and to understand that one size does not fit all.

Kaylan Baban, MD, MPH, is a public health physician, educator in digital health and the role of mindfulness in healthcare, and Preventive Medicine resident physician at the Icahn School of Medicine at Mount Sinai. She is also a passionate mobile health developer, consultant, and enthusiast. Follow her on Twitter: @KaylanBaban