During the Opening General Session Keynote Presentation, titled “Walking a Mile in Your Patient’s Shoes,” B. J. Miller, MD, assistant clinical professor of medicine at the University of California San Francisco (UCSF) and an attending specialist for the Symptom Management Service of the UCSF Helen Diller Comprehensive Cancer Center, described his experiences as both a patient and a physician to illustrate the myriad challenges posed by an often complex healthcare system.
He related how accessing effective and comprehensive healthcare is especially difficult for patients with multiple chronic conditions and functional limitations. This patient population, Dr. Miller said, is more likely to report unmet medical needs, less likely to report good patient-provider relationships, and have more expensive healthcare costs. Understanding patients’ healthcare system experience, he contended, enables providers to better respond to patient needs and develop more meaningful relationships.
“Healthcare is getting bigger and harder in so many ways, and I think what this is challenging us all to do is to find different ways to find new ways to work, and I think letting go of old ways of working, too,” he said. “This is summoning in us more layers of humanity. Not just our expertise and the things we layer on with our knowledge and our frontal lobes, but something coming more from the chest.”
Dr. Miller invoked the legacy of a well-known healthcare provider from a different era to illustrate the value of ensuring a comfortable environment for patients. “Florence Nightengale talked about the power of fresh-cut flowers in her patient’s room or the power of natural light in her patient’s room. She even talked about the type of floor wax she uses because it sends a sort of sheen or an aesthetic in an environment,” he said.
It’s so amazing how we starve each other of a sense of beauty right when we really need it most. Bedside manner is relegated to something inessential,” he said. “We excuse in the name of great technicians all sorts of bad behavior. I think bedside manner is probably essential,” he added.
Dr. Miller also described a changing healthcare continuum, in which more patients are living longer with chronic conditions, and the different skillset this demands. The challenge now, he said, is caring over the long term. “We’re all living with chronic diseases and dying from them. And the new muscle we have to develop is caring over time.”
Dr. Miller also cautioned about tempering the impulse to offer solutions that aren’t likely to help a patient. Though well intentioned, he termed this tendency the “new negligence.”
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