The Blog to Transform Advanced Care
Advancing Care through Innovation, Observation and Collaboration.
After practicing medicine inside the world’s elite healthcare institutions for 38 years, David L. Brown, M.D. thought he understood healthcare, especially end-of-life care. He had special clinical and research expertise in pancreatic cancer pain control and often walked along his patients during their last months. Near the end of his academic career, he almost died from multi-organ failure in his surgical intensive care unit. His illness gave him a gift that no medical training provides – a first-hand look at how powerful incentives inside our health system quickly overpower the unique values and goals of individual patients, even with advance care plans in place.
Dr. Brown was truly a medical insider, he spent years leading departments of anesthesiology, critical care and pain medicine teams, while editing journals. He also spent years in national leadership of many organizations, including the American Board of Anesthesiology and the Accreditation Council for Graduate Medical Education. When he became ill from his hepatitis C chemotherapy in 2012, he was leading the Anesthesiology Institute at the Cleveland Clinic, with its six departments and the nearly 1000-member team.
When asked about his illness, he said:
“I should have received another month of chemotherapy for my hepatitis C, but an acute illness with Epstein Barr virus intervened on top of my weakened and immuno-suppressed state. I ended up in our SICU at the Cleveland Clinic, where for three-and-one-half weeks I went back and forth between unconsciousness and wild delusions. I lost decision-making capacity early. My wife and family were faced with decisions about continuing my critical care life support. Some of my critical care team thought I was suffering and due to the severity of my illness, believed my treatment to be futile and that my life support should be compassionately withdrawn.
“During my ICU stay I could not speak my thoughts, and my eyes were mostly closed, my face was “mask-like” but my hearing was often active, and I understood much of the talk around my bedside. Clinically, I knew I was dying and thought it odd to know the mechanism and time of my death. My family stood at a crossroad, my wife, physician daughter and attorney son tackled whether I was suffering sufficiently – and with no hope of survival – to frame their decision of withdrawing my life support.”
The education Dr. Brown describes taking away from his chronic, then critical illness, is how too often utilitarianism, disguised in the form of clinical decision-making, creeps close to individual bedsides. The story of a unique human being is often missing from the electronic health record and from clinical conversations. The drive to knock the variability out of hospital processes to improve quality, often knocks the individual out of clinical discussions. Clinical production pressure, masquerading as efficiency, amplifies this loss of individual distinctiveness.
He and colleagues in Cleveland, OH, Austin, TX, and Hayward, WI have launched a firm, Curadux (www.curadux.com) that is focused on healing consequential healthcare decision-making for individuals, not by practicing medicine, yet by assuring individuals and families make informed decisions that they will never regret.
Curadux assists individual beneficiaries of self-insured employers, health insurance brokers and insurers’ access to experts and tools to ensure that the care a patient receives is just the care the individual and family want. Using a HIPAA-compliant app with family or advisor supporter portals allows them to join a physician care guide and ill-member, if able, via HD video in an iterative discussion and planning journey for their advanced illness.
Curadux physician care guides also assist their members in creating their personal health story. This health story paints their picture of uniqueness and catalogs their values and goals for living with their illness. The team adds individual-specificity and patient-focused education back into the advanced illness discussion. Further, a file vault within the app is for our members to load with their key documents, including health records and advance planning tools, all with physician guidance. These are available anywhere a device is connected to the internet.
As Dr. Brown related, helping Curadux members make informed decisions they will never regret is the passion he and his team honor, now and into the future. He went on to to share what a blessing he feels in being able to blend his physician brain with his patient heart.