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I remember once going to see a patient.
The, house staff said that she simply had asthma.
And we went to see her and she did indeed have asthma, but what had been
missing from the story is that this around the mid-September.
She had lived in New York, and on September 11th,
she was in the World Trade Tower when the planes hit.
And every year, as September 11th came by, her mild asthma would get much worse.
It was this part of her story that was really behind the exacerbation of her
asthma, and if you didn't know that, you couldn't help make her really better.
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>> When a physician treats a patient as if they are a generic patient, as
if they were like every other patient they've
seen, they're at great risk of making mistakes.
The only way to address that gap is to get to know that patient.
You a little earlier, and I couldn't find that many pictures, and I'll try to
look for some more, but we were talking about the little bag that they use to
>> There's really no
>> to take out.
>> There's really no reason why doctors in training should have to have so many
patients to take care of so quickly and so we decided that
we would reduce the number of patients on one of our in patient services.
>> The idea is that we have them rotate on the li, Aliki service.
They learn how to get to know their patients very well.
They learn important aspects of transitions of care.
They can do that in a slower pace, so that when they're in, back in the
faster case environment, they hopefully will carry some
of those things over and do a better job.
>> Aliki simply gives you the opportunity to be a better doctor.
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Hi, I'm Ryan Childers.
I'm one of the internal medicine interns here, and
most the year we have a lot of patients.
Have limited time to really know the patients in some circumstances.
So that's really what's great about a Aliki.
We get a chance to, really explore, you know, the personal lives of the patients.
So one thing we like to do is present, kind of
go over the details of your story here at the bedside.
>> Okay.
How they, how that effects their, their conditions, how that
might effect, how they do once they leave the hospital.
>> It gives you the opportunity to practice and
be the kind of doctor you hoped you could be.
So, I was excited about the opportunity to do that, and
when you, you know, at least for a few weeks a year.
It also gives us as medical students, more time
to sort of go through the labs, their presenting
symptoms, and sort of get to understand, also the
disease process that they've presented with a little bit better.
We're spending more time at the
chalkboard talking about the pathophysiology of disease.
How does a certain medical condition develop?
What are the risk factors?
How can we impact on it?
What is the science behind what we're learning?
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>> The home visits have turned out to probably be the richest part of the
experience so far, or at least it's the part that's, most unique to the resident.
Now this is an opportunity to learn if you got the answers to the test right.
Hi, Mrs. Lower, it's good to see you.
>> Oh, you're hands are warm.
Usually you don't ever learn that in the hospital, you do the best you can
to take care of them, you discharge them, and you hope that they do well.
Here we get to find out well, yes, they
did get better on the antibiotic, or no they didn't.
It turns out it wasn't pneumonia after all.
It was heart failure.
>> So these are both of your pill boxes?
This one is the morning [CROSSTALK]
>> The physicians at [CROSSTALK] treated me like I was a human being.
They were concerned about my welfare, and its some of the
doctors that I would, have run across would take a few lessons from them.
I think the whole world would be a lot better off.
>> We do tape those home visits so that we
can use the experience to then teach other house staff.
I think the one theme that really has come out over and over again is people realize
that patients very commonly, when they leave the
hospital, don't take what we think they're gonna take.
>> I'm confused.
>> I understand, cuz you have a lot
>> How many times do you take this one a day?
>> Once a day.
Mm-hmm.
It should be twice a day.
>> Well, I'm trying to stretch it out.
It's expensive.
>> The most pressing health care crisis on the horizon for the U.S. right
now is management of chronic illness, and
that's really what's driving health care costs today.
Illnesses that require long term management on the part of the patient.
>> When you say better and cheaper in
the national health care debate, now you got people's
attention, and I think that Aliki is not
a fancy shmancy new gizmo that can diagnose cancer.
It's a way of being a doctor that I think will catch on, and I'm hoping
we'll also have important affects on health outcomes, and on health economy.
>> There is an ah-ha moment that goes when
a resident or medical student has the opportunity to
interact with the patient and see how important it
is to that patient but also to experience for themselves.
How we're wording it is as a physician.
>> You know, it gives us time to be able to do right by a patient, and you
know, to get that gratitude from a patient is really enforcing and
informing how I personally want to practice in the future.
A simple phone call to the patient or family once they've left
the hospital means a tremendous amount to them, and I think sometimes
you can pick up on a few things that you can let
someone else know about to make
sure something's not falling through the cracks.
>> People began using the name Aliki to define good doctoring.
It take, as you would imagine, some, resources in order to do this.
>> Good morning Mr. Johnson.
>> As we try to teach residents, and interns and
medical students things, we need to actually pay for the
time for the teachers that teach that, who develop curricula,
and we actually need to teach our teachers how to teach.
The Aliki initiative sort of shows how powerful philanthropy
is, and what a difference one person can make.
And, that's really the history of medicine and it's
the history of Johns Hopkins, that a person can
have good ideas, but it's only through support of
the public, largely through philanthropy, that those ideas take off.
>> The support of Mrs. Parottini allowed us to jump-start
and initiate an important program that at its minimum has
galvanized the members of our health care team and created excitement
around the importance of patient-centered care.
>> This needs constant gardening from everybody.
It needs gardening from professors who are going to teach it.
It needs the gardening of people who are entering this field, and
it needs the attention of the public because this won't happen,
this won't continue, this never could have begun without the support of the public.
This is one of our greatest flowers.
We can't let it die.
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