Episode 12

Transition from Doctor to Patient. The Value of Patient Partnerships, with Dr. Lynn Ashdown

Guest: Dr. Lynn Ashdown

Physician, Patient and Family Engagement Advocate ​

Key Takeaways

  • Patients are what unify the independent silos of nursing, doctors, and other stakeholders in the healthcare system. There is room for improvement in allowing patient voices to be heard and being receptive to their self-advocacy.

  • Patient-partnered care involves the patient in discussing prognosis and decision making.

  • “Being involved in a patient’s life is an honor and a privilege. Our stories are what connect us. Learning about disease is different from seeing your first patient with that disease,” says Dr. Ashdownn.

    • Some medical school curriculums are incorporating patient-partnered care by implementing storytelling workshops.

A Closer Look

Dr. Ashdownn’s story

  • After completing her MD at the University of Ottawa, Dr. Ashdownn went into cardiac arrest in her PGY1 year due to congenital long QT syndrome, which was undiagnosed at the time. As a result of her cardiac arrest, she fell and sustained several fractures to the skull and neck.

  • She received inpatient treatment for 2.5 years, and to this day she is continually adapting to a new life in a wheelchair

    • Woke up in the ICU thinking she was part of rounds: she understood the medical context but didn’t realize it that she was the patient.

    • Only fully understood her circumstances once she transitioned into rehab from the ICU.

    • 1st year of recovery was focused on physical aspects of survival.

    • 2nd year of recovery more focused on the emotional aspects of processing the accident and injury

      • Experienced PTSD and depression – she reflects that resilience was helpful to overcome the frustration that’s often associated with the process of rehabilitation.

  • Currently, Dr. Ashdownn is pursuing her in MEd and serves as a patient advisor and program lead at The Ottawa Hospital.

 

Lessons from a doctor who became a patient

  • Dr. Ashdownn shares her most shocking experience as a patient:

    • “Even as a medical doctor that understands the healthcare system, I wasn’t able to navigate the system as a patient. For example, there were many miscommunications and gaps in care after being discharged from the hospital and not having a PSW or certain equipment I needed to return to independent living. This lead to return visits to the ER.”

      • As physicians, we experience 5% of the healthcare system.

      • Doctors often face notable pressure to discharge patients home in order to clear beds for other patients waiting, especially the ones accompanied by paramedics.

  • System-centered care is often mistaken for patient-centered care: medical emergencies do occur outside of regular business hours and when staff are off-duty. Healthcare doesn’t stop just because it’s a holiday or weekend.

    • She gives an example of system-centered care: When surgeons round at 6am, this isn’t an ideal time for patients to ask questions when half-awake. This might be optimal for a surgical team that needs to be in the OR for the rest of the day but becomes an inconvenience for the patient.

    • This is not necessarily a critique of the healthcare system because redesigning this system is complex, but it should be noted that there’s room for improvement in order to improve the patient experience.

      • Additional physician assistants or nurse practitioners could be helpful in improving care.

      • Some hospitals have patient navigators, who provide assistance in accessing and coordinating various health, social and community services.

      • Unified EMR can also help streamline care and prevent redundant diagnostic testing.

      • The cost of investing in systemic changes can prevent repeat visits to the emergency room when patients experience gaps in care.

  • Patient-partnered care involves the patient in discussions and decision making. Dr. Ashdownn notes that care was “done to her but not with her,” and observed that a patient can be the middle of everything without being included. “Patients are the ultimate stakeholders,” she says.

    • Ask the patient what their priorities are. Ie: Dr. Ashdownn wanted a manual wheelchair to challenge herself during physical rehabilitation but was given an electric wheelchair because her care team assumed that she’d want the easier option that restored her functionality faster. Having a brain injury made this difficult to communicate and she was initially perceived as a noncompliant patient.

    • As a patient, Dr. Ashdownn reflects that “it’s hard not to feel like your disease”. Talking about something other than the diagnosis, and even addressing a patient by name can “mean the world,” she says. She also recommends asking if there’s “anything you can do for before you go,” as another small gesture that can go a long way in comforting the patient.

    • Dr. Ashdownn wrote an opinion editorial in the Journal for Patient Experience and developed an acronym (PATIENT) to help healthcare providers to deliver patient-partnered care.

  • Her advice to patients:

    • The healthcare system is complex, don’t be afraid to advocate for yourself and ask questions about various treatment options.

    • It’s ok to feel vulnerable.

Further Readings

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