I have been pondering for sometime the seeming shift of emphasis in healthcare away from a hospital-centric model and toward a self-care paradigm; one which increasingly holds individuals personally responsible for their own health, wellness and well-being. In my musings I have coined a phrase: “heal in place.” Like “shelter in place,” it connotes a state of affairs wherein patients, as well as informal caregivers, are incentivized or otherwise obliged to follow clearly defined self-care guidelines to avoid preventable costs incurred by accessing the continuum of care.
I am in no way disparaging this approach. It is an age-old approach, taken by individuals and societies for centuries. However, after decades of hospital-centric healthcare, the necessary level of knowledge, commitment and practical know-how has dwindled. In order for patients to “heal in place,” programs and processes must be developed by the clinical community to inform, train and empower individuals and their families in proper self care and disease management. Bring the hospital home.
Much of this is being done already in a limited fashion for asthma, COPD and other disease states. But to heal in place we must go way beyond the current patient education required at the bedside or routine discharge instructions. The home must be recognized as a full-fledged part of the continuum of care along with evidence-based self care guidelines designed to be followed by patients and/or their informal care givers. Within the “heal in place” paradigm, it is not patient access to well-managed quality care that is needed so much as it is how to make quality self-care management available to the patient.
As providers and clinicians can we relinquish care into the hands of our patients? Can we see ourselves in an equipping role as trainers, coaches and facilitators? What needs to happen for everyday people to heal in place? I’ll do more to clarify these thoughts next time