Patient advocates often connect in ways doctors can't

It might sound bizarre, or at least counter-intuitive, but, some of the best patient advocates might not be doctors or nurses. In fact, they may have no clinical experience at all.

That's what Atul Gawande discovered when he met health coaches at Special Care Center, a primary-care clinic run exclusively for casino workers in Atlantic City with high medical expenses.

In a New Yorker article, Gawande describes where the health coaches at Special Care Center worked before getting a job with the clinic. One was a Sears retail manager. Another was an administrative assistant at a casino. Another worked the register at Dunkin' Donuts.

Most come from the same communities as their patients and speak the same languages. Many have watched as someone close to them struggled with a chronic condition, Gawande writes.

What's impressive is that after one year in the program, ER visits and hospital admissions for 1,200 high-needs patients fell by more than 40 percent. Out of 503 patients with high-blood pressure, just two were in poor control. Patients with high cholesterol saw an average 55 point drop in their levels. An amazing 63 percent of smokers with heart and lung disease quit smoking. When an economist compared the group's costs with a control group of Las Vegas casino workers, the clinic's group saw a 25 percent drop in costs.

To be sure, the results were a team effort, but the eight full-time health coaches--which are similar to promotoras, or community health workers found in Central and South America who help underserved communities--play a big role for the clinic. They meet every morning with the rest of the clinic staff, which includes two primary-care physicians and two nurse practitioners, to review the medical issues of patients due in for appointments. Besides working with doctors, they see their patients far more often--at least biweekly--to reinforce good healthcare behaviors.

The health coaches discovered that patients would dial 911 with problems better handled by the clinic, because they didn't know the clinic's 24-hour hotline number. Then they discovered that the patients didn't know how to program their cell phone speed dials. So the health coaches did it for them.

When recruiting these health coaches, Rushika Fernandopulle, who runs the program, said he deliberately did not recruit people with healthcare backgrounds. He was seeking a different mindset.

It was a lesson learned the hard way. Half of the clinic's first hires, which included a doctor, had to be replaced because they just didn't understand the patient service focus. "Healthcare trains people to say no to patients," he told Gawande.

Perhaps the health coaches' most valuable attribute is their ability to connect with sick people and understand the challenges they face.

The experience of one patient is instructive. She's a 57-year-old Indian immigrant who speaks Gujarati. Her husband cleans casino bathrooms for $13 an hour. Diabetes, obesity and congestive heart failure are among conditions she lives with. After a third heart attack in 2009, she could barely walk a few steps without losing her breath.

Following her first two heart attacks, she was encouraged to make changes, but never did. After the third, however, a mix of exercise, dietary changes, adjustments to drugs and close monitoring of her diabetes improved her life more than she could have imagined.

What was different the third time? "Jayshree," the woman said, naming the health coach who used to work at Dunkin' Donuts. The woman's husband said the health coach, who speaks Gujarati, listens to her and not to him. And she said she listens to Jayshree, "because she talks like my mother."

Chances are, with health coaches like that, patients would be more likely to actively manage their health. By extension, healthcare costs might not be destined to spiral out of control. If only all healthcare providers could connect with their patients that way. - Sandra