Can, May, and Ought Are Not the Same Thing

“Can” refers to ability.  “May” acknowledges permission.  “Ought” indicates a directive.  These terms apply to individuals or designated groups.  “May,” if it takes the form of law or rules or standards of practice, reflects the minimum expectations established by the permission granting individual or group.   “Ought” reveals the values of an individual or group. 

We, as a society, often spend too much time and energy focusing on “can” and “may.”  We would all benefit by lifting up “ought.”  If we aim for the stars, we should easily clear our minimal acceptable “mays” and land on the moon or another planet.  This goes for the hopes and dreams and goals of individuals and groups.

What “oughts” do you, do we, claim and display in words and actions?  What values are they based on? 

The Patient is the Most Underutilized Resource in Health Care Today

Patients are directly affected by but not intimately involved in the health care process today.  This is on an individual basis and at all levels of care, as well as on a group basis in research projects.  All healthcare organizations and providers talk about being patient-centered, but relatively few are good at including the patient in the evaluation, treatment decision, or care process. 

We know that there are differences between the gender, age, and ethnic groups, but our research studies and their relevant findings don’t always acknowledge, include, or differentiate between the various subject groups.  Different groups react differently to treatments and medications.  Individual patients do not always fit neatly into their respective “groups.”  Symptoms do not always match our well defined and searchable malady criteria. We have “informed consent,” but more details regarding procedures, risks, benefits, likely outcomes, and the length of recovery, are discussed with patients for mole removals than for invasive surgeries, the use of life-sustaining machinery, or the nature of long-term care.  The issues surrounding costs are hidden behind treatment recommendations and surface only if the patient has limited or no insurance coverage.   The seamlessness of handing care off from one caregiver to another, whether physician, nurse, or aid, most often rests on the chart notes and not on conversations with the patient and their surrogates. 

We must listen to the patient and see things from their perspective.  The Real health care and patient satisfaction that we value comes from patient participation.