I remember once I am going to see a patient, the health staff said that she
simply had asthma and we went to see her and she did indeed have asthma but what
had been missing from the story is that this was around mid September.
She had live in New York and on September 11th she was in the World Trade tower when
the plains hit and every year as September 11th came by her mild asthma would get
much worse.
It was this part of her story that was really behind the exacerbation of her
asthma and you didn't know that you couldn't help make really better.
When a physician treats a patient as if they are a generic patient, as if they
were like every other patient they have seen. They are at great risks of making mistakes.
The only way to address that gap is to get to know the patient.
What we said is there is really no reason why doctors and training ship have to have
so many patients take care off so quickly. I tried to look for somewhere.
We check them out the little bag that they used too.
And so we decided that we would reduce the number of patients on one of out Inpatient Services.
They learn how to get to know their patients very well.
They learn important aspects of transitions of care.
They can do that in a slower phase so that when they are back in the faster
phase environment they hopefully will carry some of those things over and do
a better job.
Most of the year we had a lot of patients, have limited time to really to get to know
the patients in some circumstances so that's really what is great about we get
a chance to really explore kind of the personal lives of patients and so one
thing I would like to do is to present kind of go over details of your story here
at the bed side.
The home visits have turned to probably be the riches part of the experience so far
or at least it is the part that's most unique to the resident.
Here we get to find out, well, yes they did get better on the antibiotic or no
they didn't it turns out it wasn't pneumonia, afterall it was heart failure.
The physicians that visited me that day treated me like I was a human being.
They were concerned about my welfare
and of some of the doctors that I have run across will take a few lessons form them.
I think the whole world will be a lot better off.
We do tape those home visits so that we can use the experience to then teach other
how staff. I think the one thing that really has come
out over and over again is people realized that patients very commonly when they
leave the hospital don't take what we think they are going to take.
I am confused. I understand, because you got a lot -
How many times do you take this one today?
Is it correct once a day? It should be twice a day.
Oh, try to stretch it out.
It is expensive.
It gives you the opportunity to practice and be the kind of doctor you hope you
could be.
So I was so excited about the opportunity to do that.
A simple phone call to the patient or family once they have left the hospital.
It means a tremendous amount to them. I think sometimes you can pick up on
a few things that you can let someone else know about to make sure someone else
is not falling to the cracks.
We are spending more time at the chalk board talking about the pathophysiology of disease.
How does a certain medical condition developed? What are the risks factors?
How can we impact on it? What is the science behind what we are learning?
You know it gives us time to be able to do right by a patient and you know to get
that gratitude form a patient is really enforcing and informing how I personally
want to practice in the future.
And when you are able to get something done to somebody that I think otherwise
might not have happen. I think that it's very - it feels good.
This is one of our greatest flowers.
We can't let it die.
Education changes take time.
The Aliki Initiative has spread almost everywhere at Johns Hopkins Bayview.
So we began on one service now it is on every service.
I see this now on the campus here spreading. We have talked about it in our committee
meetings about residency education
and then our presentations about the strategic direction of the future for residency
education and quite candidly I am taking this really nationally I know others are
as well when I am asked about how do you prepare the young doctor for a world in
which the public and patient expectation is that they will be protected from disease.
That they will be shielded from a complication.
One approach that is proven to be effective in one place in Baltimore is the
Aliki Initiative.
We were just really please and surprised at how people really took to this and how
it just radically changed the nature of the bedside encounter.
She was worried I talk to her on the phone she thinks that -
When I am rotating off the Aliki Service onto other services, I always think my
self this person, you know, this patient really needs to be Alikiezed.
A lot of people really think it is easy to describe the Aliki Initiative.
Well, you are just getting to know patients as people but that is as simple
it sound a very complicated thing to be able to do.
We have a lot of resources that we can tap into.
Techniques on how to interview patients during difficult situations.
Techniques on how to elicit, they are really just preferences.
So really these tools have taken a lot of time to be developed in order help us,
people to become better healers in that way.
The Aliki Initiative has had significant influence at Bayview and is continuing to
have an influence here and I think beyond Bayview is we strive to create healthcare
systems and practices that human eyes care we provide to our patients.
My grandmother would be one of people that need the time and need doctor to come to
the house sometimes and need somebody to sit there and listen to your questions.
That's important as if there, and know her history not just opps she has a heart
problem and not know the rest of her home life, her situation.
I really am glad that she did that and I am glad that that we got Dr.‬ Jay‬.
Physicians really live here with a set of tools that is really unmatch in most other places.
This initiative is really influencing and has influenced the culture of the
residency as a whole and every we graduate 12, 13 physicians that then go out
and take part of Hopkins, take part of other institutions and the values of Aliki are
so core now to this program that, that mentality get spread much beyond the walls
of this hospital and making that - the impact is really limitless.
I didn't realized what a unique experience it was really until after I left the
training program. The patient is the most important person.
It is not us. But everything we do we do for the patient.
We have people from across the country asking us about it.
The Aliki initiative here as basically said to the world - these are a qualities
and skills not just that some doctors have and some don't.
But then actually all doctors are expected to have, should have and most importantly
can learn to do effective.
The support of the society allowed us to jumpstart and initiate an important
program that at its minimum has galvanized the members of our healthcare team
and created an excitement around the importance of patient centered care.
The entire history of Aliki has beautiful cemetery with the founding of Johns
Hopkins School of Medicine.
This is an example of visionary thinking and that she has really created something
that can really redefine health care.
Not just a decease, not just one person's life but the way we deliver care which
is completely revolutionary. You could be the most phenomenal doctor in
the world and know all the answers but if you don't really understand the patient
and who they are and you don't partner with them to overcome obstacles that they
faced really it doesn't matter.
Thank you Aliki
Thank you Aliki.