Wednesday, Sep 25, 2019

Let’s Start Asking “What Matters Most?” Instead of “What’s The Matter?”

Shoshana Ungerleider, MDPhysician & Host, TED


As I prepare for my talk on October 28th at HLTH 2019, I’m reflecting on my work as a physician, End Well founder, and palliative care activist. As a clinician, I regularly meet people dealing with serious illness or nearing the end of their life. These moments bring an urgency and focus to getting to know a patient’s goals and values in order to determine the right treatment and care. I am excited to have the opportunity to share how the lens of palliative care, combined with the latest innovations shaping our increasingly customizable world, might transform the entire healthcare experience. 

The Broken System 

As a hospital-based physician, I’ve witnessed the terrible toll broken systems, miscommunication, and perverse incentives can have on patients and their families. Far too many people end up alone and in pain rather than surrounded by those they love. This is particularly true for those who are at the end of their lives. I have also seen that things can be markedly different when a palliative care team (usually comprised of a nurse, social worker, chaplain, and physician) is involved.

When I learned that the data shows the earlier the engagement with palliative care, the longer people tend to live with a better quality of life, I became obsessed with moving the dial on improving perceptions and access to this kind of care. Rather than defaulting to “doing everything we can,” no matter the negative impact on quality of life, palliative care helps people receive the care that’s in line with their individual goals and values.

Rethinking the Status Quo

When we stop to ask the question, “What matters most to you right now?” the answers can be illuminating. This got me thinking, what if we radically transformed healthcare by shifting from a top-down approach to engaging patients and their families in a completely different way?

What if the entire healthcare system was geared toward asking patients one question: What are your goals and values of how you want to live your life? We could then tailor all care based on the answers to that question. To do this, we’re going to have to stop asking “What’s the matter?” and instead start asking “What matters most?” When we do this, the patient-provider relationship becomes truly collaborative. We strive to enhance the patient’s ability to engage with their own care, and as providers, we actively engage with our patients over time. In other words, to start making this shift, we need to start talking more.

The Future of Care

Thinking about the future of healthcare through this lens requires those of us who are linear, data-driven, and analytical thinkers to step far out of our comfort zones. We must learn and become comfortable with soft skills like communication, empathy, compassion, and cultural awareness—skills that, for the most part, neither our training nor our current system enables or incentivizes.

I very much believe that the entire health care system can benefit enormously from engaging with patients in new ways across all aspects of treatment and care. What draws me to make this conclusion through the lens of end of life is that at those final moments, the stakes are so very high.

I look forward to seeing all of you at this year’s HLTH and hearing how you think we can transform healthcare for good.

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