Over the course of my career, I have seen healthcare through many different lenses. I have been a nurse, an OBGYN, a physician chief, a senior advisor at the CDC. I have been a patient and a caregiver. I have served on the leadership teams of digital health platforms that are revolutionizing the way we provide care. Over these years, I have developed a philosophy on the role of healthcare in a person’s life: as a provider, I want to practice person-centric care. We need to see people within the context of their lives, not within the context of our world as medical professionals.
When I started out as a nurse, I simply wanted to help people. As a woman, there were not many career options available, and nursing seemed like the best way to get assistance and care to the people who needed it. But my whole life I have been a questioner, and my superiors did not always take kindly to my prodding: What if the doctor instructs me to do something that I disagree with? My fellow nurses were shocked that I would presume to know what’s best for a patient.
I might not have always known what was best, but I made sure that I took the time to figure it out. I practiced deeply listening to the people who came in to see us, treating them as people and not just “patients” who needed platelets or prescriptions. On the pediatric unit, I treated a patient with leukemia. He was 7 when I met him, and 9 when he died. Over those two years, I got to know his family: his many siblings, his father who preached in the garage next to their house. I am Jewish, but I went to those services on Sunday because I was invited. I was with his mother in the room when her son died.
In those moments, I saw how different our view was from inside the hospital than it was from inside that family’s home. They had been the ones caring for their child, figuring out what death meant for their family, carrying on with their lives through unspeakably difficult, tragic years. The healthcare system was so disconnected from what they needed, and I kept trying to fill that gap. I realized that I couldn’t create the system-wide change that I knew was necessary as a nurse, and so at 30 years old I went to medical school.
After 10 years of practicing, I became the OBGYN Physician Chief at Kaiser. Now that I had control of a department, I changed everything. I realized that even though people were coming in with irregular bleeding, their real problems were depression or anxiety. More often than not, the OB problem the patient came in with was an easy fix—but the life circumstances that people were dealing with every day influenced their health far more.
I knew I had to create new models of care. We needed to be more integrated; to incorporate social services, psychologists, internal medicine, and family medicine all into one department. In the 1990s, I implemented group visits and telephone visits. I knew that people could learn more from other people in their community than they could from me. And if I could save someone the trouble of finding childcare, transportation, parking, or someone to cover their shift with a simple phone call—why wouldn’t I? Too often it seemed that if I was not doing it, no one else would.
Health doesn’t happen at the hospital. It happens one day at a time, one decision at a time, within the circumstances and the context in which people live. As physicians, and as people designing new models of care like Delfina, we need to decide: are we going to prioritize the healthcare system’s goals, or the patient’s goals? Our world might be confined within the walls of a hospital, but trips to the doctor’s office are only one small part of theirs. We need to shift the perspective of medicine to start at the patient and move outward. Not only patient-centric, but person-centric: because they are not always patients, but they are always people.
