By Clement Bottino, MD, Fellow in General Pediatrics at Children’s Hospital Boston’s Primary Care Center
Like many people across the country, I was sad to hear about the passing of Steve Jobs.
I grew up with the technology Mr. Jobs created. My 5th grade final science project entitled “The Moray Eel” was typed on an Apple II computer. My college soundtrack was powered by a first generation iPod and nowadays I keep in touch with my sister who lives in Spain using face-time on my iPad.
The technology Steve Jobs created radically changed how we interact with computers, the way we listen to music, even the way we communicate with each other. Mr. Jobs was an innovator on a grand scale; some say a Thomas Edison or Henry Ford for our time.
Before Mr. Jobs, computers were big, clunky machines. There was no mouse, no desktop, just a solitary green cursor on the lower corner of an empty black screen. You needed to be an expert in the field to use one.
Mr. Jobs’ completely rearranged that model. By thinking differently and creatively, he built computers that could be used by anyone. Nobody thought it would work, but his computers, and everything else he developed, became a wild success.
I came to Boston two years ago as a new pediatrician in the Children’s Hospital Primary Care Center (CHPCC). We care for lots of children at CHPCC, over thirteen thousand each year. Most come from Boston’s inner city neighborhoods. They are often poor, from racial and ethnic minority backgrounds with low parental educational attainment.
During my time in CHPCC, I’ve cared for countless children with health problems related to the environments in which they live, learn and play. These children struggle with obesity, asthma and mental health problems in large part because of the conditions around them.
Sometimes it’s easy to fix the cigarette smoke in the home of a toddler with wheezing or help a teenager who lives in an unsafe area be physically active outdoors. Sometimes the stars align (there’s a highly motivated family, and a locally and financially accessible community resource) and we can make a dent.
More often, however, circumstances are complicated. Unemployment, food and housing problems frequently occur together and can be difficult to fix. Anxiety and depression can crush a parent’s motivation to make healthy changes. The results are difficulties with sleep, with school, with physical activity and healthy nutrition that are often so intertwined they can be impossible to peel apart.
As a primary care provider, the system often feels like a “pre-Steve Jobs” computer. The issues children and families are facing outside the clinic walls are so huge; any dent I’m able to make feels so small, like a lonely green cursor in the corner of an empty black screen.
Things are clunky and complicated. It takes several steps and extra time to locate community resources, to communicate with schoolteachers, to coordinate care with other health care providers. Like the expertise needed to operate an old mainframe computer, access remains limited for many disadvantaged children for things like physical activity and healthy nutrition.
We need to be like Steve Jobs. We need to innovate.
We are innovating already. I’m leading a study in CHPCC where we’re using the Internet to learn about how problems like unemployment impact the quality of what young children eat at home. We’ve started programs like the CHPCC Asthma Action Team, designed to help parents not only with their child’s asthma medicines, but also to help them maintain a healthy breathing environment at home. Since the Asthma Team started at CHPCC, we’ve seen the number of visits to the emergency department and overnight admissions for asthma drop remarkably.
But we need to do more. We need to think like Steve Jobs and imagine better things and then make them happen if we are going to fight the tremendous public health issues like obesity, or make health care costs manageable, or maintain the doctor-patient relationship in the context of ever-shortening visits.
One approach is the patient- and family-centered medical home, which takes the traditional doctor’s-visit and flips it on its head. Instead of seeing just one doctor, patients are cared for by teams of doctors, nurses, pharmacists and social workers who work together alongside local community organizations to create environments that promote health.
Steve Jobs’ vision was a radical departure from the conventional model. The issues we face now call for a radical departure from our conventional health care model.
We will forever miss Steve Jobs and his creativity and passion. If we can apply that kind of creativity and passion to health care, we may achieve the radical change the system so desperately needs.