Beyond the Hospital Walls: A doctor’s lessons in Person-Centered Care
After relocating to the United States, my career took a pivotal turn as I began working with JASA, a leading provider of services for older adults in New york City.This experience quickly illuminated a gap in my medical training – the realities faced by patients after discharge from the hospital. While medical school focused on treating illness, I discovered the profound impact of social determinants, daily struggles, and isolation on recovery and overall well-being.
One patient, whom I’ll refer to as Mr. Happy, profoundly shaped my understanding. He had recently been released following a lengthy hospitalization for congestive heart failure and ascites related to colon cancer. Initial contact proved tough; a social worker cautioned me he was frequently enough unreachable and resistant to engagement. However, once we connected, he became an invaluable teacher alongside being my patient.
my first significant realization came during a home visit. Mr. Happy’s apartment was almost bare. His belongings had been discarded during his hospital stay, leaving him without basic necessities – a chair, linens, even clothes. He understandably felt anger and shame. Fortunately, through JASA’s resources, we were able to provide him with clothing, shoes, linens, and a pleasant recliner.
Reviewing his medications revealed another critical barrier. He had stopped taking his heart failure medication due to its cost without insurance coverage. I proactively contacted the pharmaceutical manufacturer, secured a coupon, and coordinated with his pharmacy. Within hours, he had his prescription filled. We then meticulously reviewed each medication together, utilizing the “teach-back” method to ensure understanding, and created a simplified list for him to follow. He consistently took his medication from that point forward, highlighting how labels of “non-compliance” frequently enough mask significant, practical obstacles to care.
The most transformative shift in my approach came with JASA’s adoption of the Age-Kind Health System framework, centered around a single, powerful question: “What matters most to you?”
This question fundamentally altered my perspective. For Mr. Happy, regaining his health meant spending time with his family – his son and siblings - and returning to his beloved chess games in the park.We worked collaboratively to achieve these goals, arranging transportation, medication delivery, and home aide support, and assisting him in securing ongoing insurance coverage.
I learned that genuine healing begins with truly listening to a patient’s priorities. Mr. Happy evolved from a patient into a mentor. During my final visit, we shared a game of chess, honoring a central element of what mattered most to him. He reinforced the importance of compassionate, person-centered care, built on empathy and a true partnership between doctor and patient, as the very foundation of medicine.
(Dr. Jose R. Martinez-Escudero is the associate director of transitional care for JASA at Maimonides Hospital, where he supports underserved older adults navigating the healthcare system in New York City. He received his medical training at the National Polytechnic Institute in Mexico City and holds a master of Science degree focused on research in Parkinson’s disease and the basal nuclei.)