August 2023Spotlight feature

New book by Dr. Lawrence Rosenberg explores healthcare revolution that’s already under way

“Patients Matter Most” urges patients to be more knowledgeable and responsible for their own care

Even before you flip open the cover of the new book by Dr. Lawrence Rosenberg, President and CEO of CIUSSS West-Central Montreal, its title—Patients Matter Most: How Healthcare is Becoming Personal Again—raises a flurry of questions.

The first three words, Patients Matter Most, seem so obvious that you might wonder why they’re there at all. In a clinical setting, who but patients would matter most? Aren’t they the raison d’être for the healthcare system? Aren’t their needs and concerns already the highest priority?

“If the statement in the title were really true, our healthcare system wouldn’t be in the mess it’s in today,” replies Dr. Rosenberg, adding that the wording of the title is meant to provoke questions that tie into the book’s main themes.

Dr. Lawrence Rosenberg with his new book, Patients Matter Most.

Dr. Lawrence Rosenberg with his new book, Patients Matter Most.

“The fact is, we have the most expensive healthcare system, but the worst results of all of the countries in the OECD (Organization for Economic Co-operation and Development). It can’t be that we’re not putting enough money into our system, because we’re putting in more than any of the other OECD countries. And yet, we still have the worst results.”

Patients Matter Most, recently published by Forbes Books, is both personal and panoramic in its perspective, covering such topics as the decentralization and digitization of care, the need for patients to take a more active role in their own care, the trend toward personalized medicine, and the looming presence of AI.

“It’s not so much about what lies ahead as what’s unfolding as we speak,” Dr. Rosenberg explains, adding that the book is targeted at a broad audience, including average readers, medical specialists, senior administrators and policymakers.

“My objective was to make sure that the various constituencies all read the same thing and receive a consistent message,” he says. “It wasn’t as if I were planning to write one book for doctors and another book for politicians and yet another book for the citizenry. Everybody gets the same book and they take from it what resonates for them.”

In the past, Dr. Rosenberg has edited books, and has written book chapters and peer-reviewed articles for scientific journals. Patients Matter Most is his first full book as a writer, a product of “having been in the system at various levels for over 35 years and deciding I might have something to offer in terms of insight and the things I’ve learned.”

The book was written as the worst effects of the COVID-19 pandemic were receding, from about December 2021 to December 2022. “It’s a huge feeling of satisfaction and relief at how it turned out,” he says.

“It was a good opportunity to look back over my career and pick out the things that I think are important to document. That meant charting how health care has evolved and where it’s going.”

Many of the concepts in Patients Matter Most are already a reality in CIUSSS West-Central Montreal. Among them:

  • the Hospital@Home program, in which certain patients conclude their recuperation at home while being remotely monitored with digital technology
  • OROT, the CIUSSS’s connected health innovation hub
  • the Command Centre, which offers a bird’s-eye, real-time view of clinical activities throughout the CIUSSS
  • an overall approach known as Care Everywhere, aimed at achieving the right outcomes by delivering the right care at the right time in the location that’s most appropriate, safest and most convenient for healthcare users

Dr. Rosenberg notes that even if he hadn’t described developments in his own CIUSSS, “I could have cited other examples from many other places. A great deal is on the way and is yet to come, but the first steps have been taken, and not just by us.

“Now it’s not only up to hospital administrators to maintain the momentum, it’s also up to patients to advocate for themselves. Citizens, who may or may not be patients, need to demand what they’re entitled to.”

This is an ideal time for patients to do more for themselves, Dr. Rosenberg believes, because digital technology is opening up possibilities that didn’t even exist as recently as five years ago.

“For instance, in their own home setting, patients can take advantage of telehealth, remote monitoring and even examining themselves. Sometime soon, we’re going to introduce technology that will allow patients to conduct a complete physical exam on themselves in their living room or have a family member do it. It would produce perfectly acceptable results that could be transmitted to a treating healthcare provider.”

“A relationship still has to be established between a caregiver and a patient, but how that happens needs to be rethought.”

Dr. Rosenberg acknowledges that some people may have misgivings about the growing digital presence in medical care, “but that doesn’t necessarily have to lead to the depersonalization of medicine.

“A relationship still has to be established between a caregiver and a patient, but how that happens needs to be rethought, just as it’s being reconsidered or rethought for other aspects of life. Banking, booking tickets for an airline trip, shopping—everything has become a little less face-to-face. This doesn’t mean the experience has become worse. If anything, it’s more convenient.”

Some may argue that this new system will make it somewhat harder for patients to develop a relationship with their doctors. However, Dr. Rosenberg says that, with certain exceptions, these relationships are generally not especially close to begin with.

“If you have a family doctor, you may see him or her once a year for 15 or 20 minutes at most,” he explains. “Will this really result in a personal relationship with someone who cares for you?

“It may vary, of course, depending on the type of doctor you’re seeing. If someone’s going to operate on you, there’s something to be said for the relationship between the surgeon and the patient. But even that is short-lived.

“Several years ago, my own family had someone admitted to a hospital and the physician who was on service in the ward that week approached them. “‘It’s nice to meet you,’” the physician said to the family, “‘but I have to look after 70 patients, so I probably won’t see you for the rest of the time that you and your relative are here.’

“Great way to establish a rapport, eh? Too often, unfortunately, that’s the way it still is. But now we have the opportunities and the tools to make significant changes.”

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