Naming conventions highlight underlying disease-centered philosophical approach to healthcare
I remember a character created by comedian Bill Saluga back in the late 70s named Raymond J. Johnson Jr. When the character would be addressed as “Mr. Johnson,” he would go into a loud shrieking voice saying, “My name is Raymond J. Johnson Jr. Now you can call me Ray, or you can call me J, or you can call me Johnny, or you can call me Sonny, or you can call me Junie, or you can call me Junior; now you can call me Ray J, or you can call me RJ, or you can call me RJJ, or you can call me RJJ, Jr., but ya doesn’t has call me Johnson!” In our present healthcare environment, we have fallen into this trap. We label people by their disease or condition. We call them heart failure, diabetic, dementia, even normal pregnancy.
This naming convention has even led us to think about care models in the same way. We have historically focused on disease management. We have created clinics that solely focus on a disease state. We have diabetic education clinics, heart failure clinics, even medicine clinics such as a Coumadin clinic. I get at least two emails a day with someone trying to sell me a disease management tool.
Our payers have tried to solve this by creating disease management programs. We get asked all the time “do you have a diabetic program?” When a person has multiple issues, we label them as multiple chronic diseases.
By looking at those who we serve through this lens, we have completely missed the boat. We are taking care of human beings that happen to have certain illnesses. They do not view themselves as their disease so why should we look at them that way? Why should we treat them as a disease? This way of thinking has prevented us from truly caring for those in need.
To truly create value for those we serve, and decrease disparities that are presently occurring in healthcare, we need to see them first as human beings, and then see what conditions they have and treat accordingly. By taking this approach, we will first address the needs of our patients from a humanistic standpoint instead of a disease-based approach.
I have had to explain many times to people that our approach is to define what each person’s barriers to care are first, and then focus on their disease issues. They look at me and basically say that I do not have a disease management model. They are correct, we have a human needs model that also focuses on their disease. This phrasing is just not a play on words. It is a philosophical construct that I believe will better create value for those we serve. Our old way of thinking of things has gotten us to where we are today. Yes, we have evidence-based medicine to treat diseases, but we also have evidence-based ways of treating humans that create activation and engagement. Let us try this approach of looking at the psychosocial needs of those we serve first and then look at their biomedical needs. Please don’t call me diabetic.