It may sound ridiculously simple, but one of the most important things a health care provider can do is to simply show up. I worked as a home health nurse for 15 years and continue to make home visits in my current position. I am just beginning to understand the value of consistent contact with people who want to have a better life.
People's lives become defined by diseases such as heart failure, cancer, chronic lung disease, high blood pressure, coronary artery disease, arthritis, depression, bipolar disorder, diabetes. The list is long. They should not have to suffer from a lack of support to help them cope with diseases.
Once someone shows a willingness to want to engage in self-help it becomes clear, in most cases, that they can't do it alone. Often, what happens is that they see their health care provider on a regular or irregular basis. Most people with "active" chronic diseases develop varying degrees of therapeutic relationships with their providers.
The problem is that most of the relationships are just too functional. That is not to imply that some providers do not spend time with their patients to explore feelings and to dig deeper into the mind-body connection. That does happen, but is the exception rather than the rule.
What I am beginning to understand is that it doesn't matter whether or not there is a scientific, evidence-based reason to have an encounter between patient and provider. There are many instances in which just showing up is all that is needed to make someone not only feel better but also to counteract some of the side effects of chronic disease.
I haven't seen any studies on the topic, but I can tell you that seeing people on a regular basis every week or every two weeks can make a difference in how they feel and how disease affects them. Sadly, this schedule may not be realistic in a health care world controlled by insurance company reimbursement, but there could be an opportunity to change things from the bottom up.
Here's what I am proposing. It is not practical for office-based providers to make home visits, but they can schedule more frequent appointments with their patients. Imagine if a provider said that they want to see someone every two weeks to get to know them better and to understand how to help them have better control of their life.
The first message would be that someone cares about them as a person and not just a disease entity. Providers may be restricted to short office visits, but they could have longer visits every few months. Imagine if patients knew that when they went to a provider that they had a chance to develop a long-term therapeutic relationship instead of just showing up to monitor symptoms and get things fixed.
I suspect providers would also welcome developing these new kinds of relationships. They try to understand how disease affects the person and not just the body, but the current manner of doing business gets in the way.
One of the areas where the most impact could be delivered is in the area of home health provided by visiting nurses. There was a time when home health nurses were not restricted by the number of visits they could make to each patient. In the "old days" they could see people as often as they felt necessary and it was not uncommon to visit someone every week for years to not only keep them out of the hospital, but also to let them know someone really cared about them. You can't deliver that in a pill.
The current system would have to undergo major change (some of it is happening in some places) for providers to be able to simply show up as often as they felt necessary. It is a sad commentary on our health care system. Until we head in that direction, we will not be able to make the kind of progress in disease prevention that needs to happen.
Richard Davis is a registered nurse and long-time health care advocate. He writes from Guilford and welcomes comments at firstname.lastname@example.org.