In this TedMed 2012 talk Rebecca Onie, CEO, Health Leads explains of how they’re putting “a desk in the waiting room where they have a core of well trained college student advocates who work side by with these families to connect them out to the existing landscape of community resources” using their unwillingness “to take no for an answer from those bureaucracies that tend to crush patients and with an unparalleled ability for information retrieval honed through years of using Google“:
Rebecca’s approach seems to have been arrived at through examining a waiting room for faults rather than looking at the opportunity we have to re-engineer the processes of how patients and carers engage.
I think it’s becoming increasingly obvious that best practice will involve the elimination of waiting rooms where asides from the waste of time it’s also common to see patients with unrecognised contagious illnesses being exposed to one another for prolonged periods, and a movement towards systems where patients are admitted directly into examination rooms on arrival.
I’m of the opinion that putting students into sick environments is a waste (they could probably be better tasked with helping families manage care, cooking, writing CV’s, teaching them how to read/use the internet, etc) and will only continue to give us more reasons to maintain the wasteful “waiting” part of our healthcare system rather than acting on the opportunities we have to make radical reform.
I wonder if Rebecca has ever sat in with a Doctor as they asked a patient some of those very sensitive “real issue” questions eg. Do you know where the nearest food pantry is? how many other people live in your 2 bed apartment? Are you running out of food at the end of the month? Do you have safe housing?
Looking at the very 1990’s clipboard form that Health Leads are using in the waiting room at the Childrens National Medical Centre (a 140 year old Hospital that last year provided $1.5 Billion worth of care) I wonder if Rebecca has ever had a patient experience like that they’re promoting at Health Leads? Personally I cannot even begin to think how bad it would be to have to give answers to sensitive questions to a volunteer student while I’m waiting for my child to be seen for an asthma attack, although my first answer might be something along the lines of “I’ll answer all your questions if you can tell me where all the Doctors are!”.
I also wonder how this works if they’re caring for children who might be on social service ‘at risk’ lists (like those who Rebecca tells us are living in 2 bedroom apartments with 11 others) as I could imagine these parents might be much more guarded about honestly sharing such personal information in writing with unqualified volunteers who could potentially use it against them, share it inappropriately on facebook/blog/twitter, etc.
Refreshingly Dr John Bachman, Prof of Primary Care at the Mayo Clinic, explains in the following video how he has managed to replace the need for 80% of in-person consultations (and the waiting room experience associated with these):
The interesting bit is unlike the up-all-hour students this is technology that can be used before going to the ER waiting room or in it and it’s incredibly low cost, discrete, patient, private, scaleable and trained to an expert level already.
With the growth of the mobile internet in the USA (more than half of ALL mobile users in the USA have accessed the internet on their mobile) we can now offer medical history taking skills with an abundance of patience whenever and wherever a patient requires it – giving us the possibility of helping patients decide if the waiting room is even necessary…