Why patient centered care isn't enough

Right now I'm hearing a lot of my friends talk about how they can't imagine a world without police. Which makes a lot of sense, because how can we imagine how something we've never seen?

Surprisingly, reading through conversations online about why police reform isn't enough reminds me of discussions about patient centered care.

The first time I heard about patient centered care and family caregivers as partners it sounded like a great idea. Finally, they'd take patient and caregiver concerns seriously! Services would be integrated and things would go smoothly. We'd get support.

Yeah, it sounds great. But that's not how it plays out. They roll out a new logo or something and use new jargon, but our experience of the healthcare system doesn't change in any meaningful way.

I've found healthcare leaders to be happy to meet with me and invite me to their events. That's when I realized that their motivation for patient centered care is to reduce lawsuits and increase profitability. That they're eager for us to be care partners in order to improve patient compliance.

They know the healthcare system is profitable because of the free labor family caregivers provide, so they want to figure out the bare minimum to keep us doing it. They don't care to figure out how to create a healthcare system that serves the needs of the people who need care, they'd rather put family caregivers to work getting patients to comply with their orders.

The healthcare system isn't going to become a system that meets our needs -- one that sees patients as people of value, rather than difficult patients with diseases to go to war with -- through reforms.

Thankfully, we don't have to choose between accepting things as they are or living without a healthcare system.

It's time to imagine what a healthcare system that treats people with dignity would look like.

The system we have in the US seems unchangeable and inevitable, but it's less than 100 years old and has undergone massive changes in the 35 years I've been alive. We can take these lessons and start over.

The same can be said about the US police. If you've ever been to a police museum, you know how much policing has changed since it began in 1844 and how different policing looks in different places around the world.

PS. I personally support using other types of trained professionals, rather than police officers, as first responders. The other day I came across a great example of why it's a problematic solution in David Graeber's Bullshit Jobs. A social worker shares their experience taking a job with a nonprofit out of a desire to help people, but finds that their job actually entails blaming the victims for their inability to rise above systematic inequality and doing things like criminalizing poverty by putting kids into foster care.

So yes, non-police first responders isn't a good solution at all, but given the rates of people being shot by police on wellness checks or through misunderstanding the behavior common with dementia, autism, mental illness, etc. it seems like a reasonable interim solution.

PPS. Another thing that comes up in Bullshit Jobs is how Barack Obama spoke about how he supposed the private, for-profit health insurance system in America because of the millions of jobs that would be rendered unnecessary by a more efficient socialized health system.

“One motive, [Obama] insists, for maintaining the existing market-based system is precisely its inefficiency, since it is better to maintain those millions of basically useless office jobs than to cast about trying to find something else for the paper pushers to do (Graeber, 2018, Chapter 5).”

We are told there is not enough money to hire adequate staff to provide hands-on care at home or in nursing homes, but it’s justifiable to retain millions of workers who are performing work that is acknowledged by all to be unnecessary.