My Life, My Story: VA Program Humanizes the Care Experience

Added on Jul 2, 2018

pixabayAs health care becomes more technology-driven, even one of the most personal aspects of care delivery—collecting a patient’s history—can feel transactional. The need to quickly fill in the blanks of an electronic health record can interfere with face-to-face, compassionate communication, leaving patients feeling dehumanized and clinicians underfulfilled.

“As clinicians, we want to connect with our patients. We know how important it is to recognize them as people and not as a diagnosis or problem list,” said Dr. Susan Nathan, a specialist in geriatrics and palliative care at the VA Boston Healthcare System and an instructor at Harvard Medical School and the Boston University School of Medicine.

But a recent study shows that most U.S. physicians have only 13 to 24 minutes to spend with each patient. So how can providers offer a more personalized experience of care in fewer than 25 minutes?

A VA medical center in Madison, Wisconsin, may have an answer. In 2013, two psychiatrists at the William S. Middleton Memorial Veterans Hospital received a grant from the VA Office of Patient Centered Care and Cultural Transformation and created the My Life, My Story program as a way to foster a more intimate connection between VA patients and providers. 

The program offers patients the opportunity to share their stories through interviews conducted by a rotating cast of community volunteers, social-work interns, medical students, clinicians and others. Veterans who agree to participate are free to talk about themselves, their families, their military experiences—“whatever they want,” Dr. Nathan noted. “It’s all driven by the veteran, which is different from a usual care visit in which the provider is pushing a particular agenda and interpreting what the patient is saying.”

The interviewer writes the story and then reads it back to the veteran to check whether anything should be changed, added or removed. The story is then added to the VA electronic health record with the veteran’s permission so that any member of the care team can learn more about the patient in fewer than 10 minutes, according to Dr. Nathan.

The program aligned so well with the VA’s mission of honoring veterans’ voices and experiences that it has been rolled out to 18 VA medical centers and recommended for implementation nationwide by the Veterans Experience Office.  

Dr. Nathan spearheaded the program in April 2016 at the Brockton campus of VA Boston after happening upon a story in a patient’s chart. “This patient was very ill. He couldn’t talk or communicate. He didn’t have any visitors. He didn’t have any pictures. I knew the facts of his medical history, but I didn’t know anything about the person I was taking care of. Then I read his story, and it just transformed the whole experience of care,” she said. Feeling more connected and resilient, she began integrating this program into her own day-to-day practice and sharing it with other clinicians.

Once the program grew in popularity at the Brockton campus, Dr. Nathan looked to expand it to other campuses as well as various care settings. As a clinician educator, she knew the best way to develop it further would be through “learners”—a comprehensive term referring to students, interns, residents and fellows in various areas of clinical practice receiving training across the Boston VA system. “It grew wherever the learners went and, as a result, is now carried out in the outpatient clinics, physical rehabilitation units, hospice and palliative care unit, inpatient hospital, emergency department and even in veterans’ homes,” Dr. Nathan said.

The My Story interviews foster meaningful connections that transform clinicians’ ability to deliver care by humanizing the patient. “Having these stories helps clinicians understand that the person is not just a veteran, not just a Marine, not just the Vietnam War. Their military experience is part, and often a really important part, of their identity, but there’s so much more to the person,” Dr. Nathan said. “Often, what we might think is the biggest, most defining thing is totally different from what they tell us in their story.”

According to Dr. Nathan, this insight can also inform the course of care. “Clinically relevant information often comes out when people tell stories about hard times they’ve faced in the past, because we can learn how they’ve been resilient and what inner strength they’ve called upon and may be able to call upon again, in facing their current challenges.”

Dr. Nathan hopes the program will continue to grow, both within and outside of the VA system. “I hope that within the next five years or so, it will become part of the culture. I don’t see why this couldn’t be done anywhere with any patient in any hospital system,” she said. “How do you get to know the whole person? You have to ask them.”