Value-Based Healthcare is Rooted in Prioritizing Patient Needs

Melanie Raffoul, Medical Director, NYU Langone Health

Melanie Raffoul, Medical Director, NYU Langone Health

We are our ancestors’ wildest dreams. That hits me nearly every day. As I look at the picture of my grandmother on my desk, I feel how amazing it is to live the life I lead, and to lead in my work. Those feelings and accomplishments, those duties and those responsibilities can flood one with so much emotion. That, coupled with the speed by which we live our lives, can lend itself to action without reflection. I have tried to focus on always thinking, in between feeling and acting. This does not come naturally for me.

What does this have to do with leadership? Before picking up the mantle of leadership, even mentally, I think time spent exploring one’s core values, and building a foundation out of your values and authentic self is time well spent. This is that important work between feeling and acting, that additional necessary step that keeps you in touch with your ‘why’, and shapes your personal ultimate measures of success. I think this is the essential part of the journey towards self-discovery, and ultimately towards the discovery of one’s purpose. And you’re never done doing this valuable work, not if you want to remain relevant and vital.

With what the patient needs as the center, there is no room for ego. There is a commitment to life-long learning

I’m a physician. My first time contemplating what that meant as far as purpose and markers of success happened in residency. I had a few patients die. These cases were gut-wrenching, and completely inevitable. This inevitability didn’t allay my turmoil. It wasn’t until I had a beautiful patient (who was terminal, news that fell to me to convey) teach me what my job was as her physician. She was worried about various social issues pertaining to her family. These were things I could impact. And a lightbulb went off.

I’m the doctor. Doctors don’t heal (we aren’t supernatural). We don’t thwart death (we aren’t God). Up until that point my unconscious expectation of myself as a physician was that I would heal and lead my patients to a healthy life. This, as a benchmark for success, was an utter set up for failure. It was also a most arrogant viewpoint, and one that inflates the physician role, at the expense of the most essential element of being a doctor: personal humanity. She showed me that my job as her doctor was to do what she (the patient) needed. Healing: the removal of pathology regardless of its progression, is not something that I CAN do. What I can always do, is what the patient needs.

Not what she, or the family, or the team wanted. (Of course, these wants matter). But the bare bones foundational concept of what I do as a doctor has to center first on what the patient needs. A burden fell off of my shoulders, and the simplicity and steadfastness of this concept has been a foundation that I can return to whenever I am overwhelmed and pulled in different directions. I bring it back to the patient. This centers my outputs, as their doctor, on what matters.

With what the patient needs as the center, there is no room for ego. There is a commitment to life-long learning (as what the patient needs will change with our research and developments along disease process and treatment). This opens up the space for a frank “I don’t know”, a phrase we as docs have become reacquainted with since the rise and dominance of COVID-19. There is also a weight placed on effective and collaborative communication, for the patient is the ultimate stakeholder in any plan we create, and their trust, their ownership of their charted course is essential to that course actually being taken. There is also an imperative consideration of the patients’ context. No treatment, no care plan will succeed in addressing the patient’s needs without the patient becoming a person in the eyes of their doctor. Context is prioritized in the pursuit of defining what the patient needs.

Now I am a physician in leadership. I am still here to do what the patient needs. I am also here to do what the team needs. This simple foundation lights the way to fundamental questions: How can I foster a culture of safety and of joy? How can I encourage a culture of continuous questioning in the pursuit of good evidence and sound knowledge? How can I correct and counsel team members while keeping them, and the patients, at the center? How can I authentically praise their work and find opportunities for their growth? There’s no one way, there’s no manual for this (and by no means are these the only questions to ask) but if I keep the patients and the team at the center, I can model lifelong learning, and highlight its value, which will keep ego at bay. I am reminded that I need to understand the context of every team member, and as much as possible understand their ‘whys’ and ‘where froms.' And I know that without authentic communication, not one objective will be met. This is what it means to say “culture eats strategy for breakfast." With a culture centered on patients and team, we cannot fail as physicians. And as physicians, we are all leaders, whether titled or not.

Feel all the feels. Act boldly and with conviction and humility. But those ‘thinks’ in between feeling and acting... Those thoughts will never fail you, and as you evolve, that time spent thinking paints such a rich and nuanced picture. And, at least as much as possible, creates a life – and a life’s work – that we can look back on with pride and a conviction of purpose.

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