Incremental Care and Healthy Survivorship

Slow progress can sap patients’ hope. Atul Gawande is a surgeon-writer who offers a healing perspective in The Heroism of Incremental Care.

I kept nodding my head while reading Gawande’s discussion of the value of teeny steps toward recovery. Yes, it thrilled me when surgeons rescued my patients from debility or death with their dramatic interventions. In my office, though, I reveled in my brief visits with patients whose blood pressure or chronic pain remained well-controlled. Thrilled, I’d remember the many months of trial-and-error with medications or the years of encouraging the dietary restrictions or physical therapies that eventually led to the well visits.

Gawande argues our current model of care is off. Clinicians and patients desire quick fixes, when many illnesses can be modified, if not cured, only with slow, incremental care. Clinicians and patients need to be prepared for that, so they don’t give up hope too soon.

Incrementalists “believe that they can recognize problems before they happen…[and] with steady, iterative effort over years, they can reduce, delay, or eliminate them.” They also believe that physicians and patients need to accept that they “will never be able to fully anticipate or prevent all problems.”

Healthy Survivors invest in relationships with physicians that enable the hope and benefits of incremental care. Now Americans and policymakers need to value the time it takes for incremental care—care that can improve and lengthen lives.
[The Heroism of Incremental Care]

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