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Joseph Alvarnas, MD

Cancer Research Specialist, City of Hope

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A Hospital Without Doors

09/11/2015 12:36PM | 10306 views

If we in the healthcare industry believe that the path to good health does not begin until someone enters the hospital, we are already starting off at a great disadvantage. That’s a failed model of healthcare for all involved: doctors and nurses, healthcare providers, caregivers and patients. It’s a model that reinforces the passive patient who doesn’t question their physician or ask for a second opinion. A model that makes patients more comfortable turning to folk cures and alternative therapies instead of preventive self-screening and proven treatment methods. 


If we want patients to take a more active role in maintaining and making decisions about their health, we can’t wait until they come to us with symptoms of a chronic disease like cancer or diabetes. In this scenario, they are already under duress – physically and mentally – and at that point they are just looking for someone to take over the situation and make them better. If the patient did not have a primary care physician until then, the physician is a stranger with whom they have yet to form a trusting relationship. Without that bond of trust, the patient may not follow the doctor’s advice – or question it when they have concerns or specific needs that aren’t being addressed.

To be relevant and have influence with the community, we can no longer afford to be seen as being apart from the community. We need to become integral parts of the communities we serve, and this is where the opportunity to change the healthcare model can take root. The new model that is needed begins with the concept of what I would call “Hospitals Without Doors” – much like Doctors Without Borders brought medical care and attention where it was needed on an international scale.

In this new model of healthcare, we need to engage people where they live – in their homes, amidst their families, throughout their communities. Conversations about preventive healthcare and disease management have to happen earlier and that means closer to home. They have to become part of day-to-day life if we are to replace superstition and fear with healthier habits and self-advocacy.

Ideally, healthcare providers and specialists will work together to provide a network of support to patients and their families. That means recognizing that we don’t just treat diseases, we treat people. In this light, eradicating disease is not the end-goal. Restoring the person to wholeness is the new definition of care and what we mean by healthy living.

Once we start to make that quantum leap in thinking, the kinds of conversations and interactions we have with patients will change dramatically. We won’t have a singular focus on the disease but instead will think more broadly about it in relation to the patient’s life. Outside the hospital, will they continue to take their medication? Will they engage in healthier lifestyle activities? Will the people around them support healthier behaviors?

This last question is especially important. A doctor’s influence can only go so far because of the limited time we have with patients compared to the people they see on a daily basis. Therefore, if you’re trying to get a patient to stop smoking, for example, you’re more likely to be successful if you can encourage those around them to stop smoking, too.

The tenor of the conversations we are having with patients must change as well. As physicians, we must avoid making grand pronouncements that sound like the final word on the subject, and instead encourage ongoing, long-term conversations that are more conducive to healthy lifestyles and patient engagement. Anything a patient needs to make a decision should be on the table and open for discussion – including second opinions – so that they ultimately feel comfortable that they have made the best choice for them about how to proceed with treatment and care options.

Changing the healthcare model also makes good economic sense. If we want to reduce things like hospital readmissions and the number of people coming to the emergency room, it will take more, earlier and better quality interactions with patients before they get to that desperate point of needing emergency care. What day-to-day issues is the family coping with that keeps them coming back with the child with asthmic exacerbations? What barriers to good care is the older adult facing who keeps returning with exacerbations of congestive heart failure? Looking at these situations and others like them can be great models for improving our engagement with patients, their families – and in a more broader sense – the community at large.

With all the motivations in place, it’s time to think in terms of a Hospital Without Doors – a profound change in the healthcare model that moves us toward better overall community engagement and gives patients permission to take greater ownership over their own care. 

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