Understanding and Improving Patient Expectations: Dr. Geoffrey Ling’s Outlook

Paradigm − January 30, 2018 − filed under Complex Case Management

Dr. Geoffrey Ling, a retired U.S. Army colonel, was deployed six times: Five times to Afghanistan and once to Iraq. He spent his first tour of duty in a tiny Level I trauma center in northwest Afghanistan, where he saw children who had been injured by Russian landmines.

Because the landmines resembled butterflies, it was common for kids to try to pick them up or to throw rocks at them. Either situation was bad. BOOM! Every time a landmine was set off, it seemed that another child had lost a limb.

“Service members, of course, were facing similar types of injuries with IEDs (improvised explosive devices). But it was actually those little kids that got me thinking about [asking patients what they want most from their treatment],” Dr. Ling told Paradigm Outcomes’ eighth annual Innovation Symposium exploring outliers and medical innovation.

Ask Patients What They Want

“Patients don’t want a better wheelchair; they want to walk again. Patients don’t want a better hook; they want Luke Skywalker’s arm,” Dr. Ling said. “How do we get there? How do we go from A to Z with that in mind? That’s how we should think. The right people to ask are our patients. It’s the people we take care of.”

Don’t start by asking what’s possible or even what’s probable. Determine your patient’s highest aspirational goal and work toward it, said Ling, who upon returning from Afghanistan went to work for DARPA: Defense Advanced Research Projects Agency, which he likened to the government’s venture capital firm. He is a partner at Sun-Q, LLC, a biotech consulting group; and a professor of neurology at both Johns Hopkins University and the Uniformed Services University of the Health Sciences.

“For a boy I treated in Afghanistan, it’s very easy. He wants his hand back. So we distill this process of restoring or recovering his arm to just two task areas: neuroscience and building a robot arm,” Dr. Ling said, describing a slightly different approach to the typical process of restorative care. “I’m not saying this is going to replace traditional medicine or cognitive training. But it will be complementary.”

Learn To Say, “Yes”

On what it takes to improve a recovery strategy from not-good-enough to better or even perfect, Dr. Ling says, “First, learn how to say, ‘Yes.’”

The easiest response in cases like these is, “No: Won’t do it. Don’t know how. Can’t do it.” It protects you from trying and failing. Saying, “Yes,” to helping a patient reach their recovery goal actually obligates you to find a path forward.

Whatever strategy you choose, establish milestones, timelines and resources in advance so you know where you’re going, whether you’re on track, and if you have the supplies you need to continue moving forward.

Obstacles — even those that are insurmountable — are also valuable to the experience because they prompt you to find new routes to progress and recovery. “If an idea doesn’t work, I want to know as early as possible,” said Dr. Ling. “Fail early, fail fast. That way we can reallocate resources.”

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