Start with a blank piece of paper and a pencil.
Now think of the kind of health-care system you'd like to have. Design it from scratch assuming you don't know what kind of family you'd be born into — rich or poor, black or white, rural or urban.
What would it look like? Probably nothing like the system we currently have, said Diane Meier, an internationally known expert on palliative care.
Meier said the health-care system in the United States is broken and needs to be fixed from the bottom up. She urged people to work together and raise their voices to demand change.
"The public is very powerful, and it's a sleeping giant," she said. "Create a movement that would create change."
Meier said from what she's heard from her patients and during her travels, people want a health-care system in which doctors have more time to spend with their patients, in which they will listen better to their patients' concerns, and if they get sick will come to their homes rather than having them shuttle between hospitals and doctors offices.
"Most doctors have never made a home visit, but that's where most illness is," she said.
Meier is a professor of geriatrics and palliative care at Mount Sinai Medical center in New York and the director of the Center to Advance Palliative Care. She was here as the keynote speaker for a day-long palliative care symposium at Forsyth Medical Center Friday.
She also spoke at Wake Forest University Thursday night.
Palliative care focuses on reducing the suffering from medical conditions rather than on a cure. It deals with a wide range of issues such as managing pain, and providing help for overworked family caregivers.
Most people think of palliative care and hospice as being for patients at the end of their lives, but Meier said she'd like to see it expanded to include more chronically ill patients who are not on the verge of dying.
She'd also like to see medical education changed so that doctors couldn't leave medical school without an understanding of palliative care.
That would include knowing:
•How to prescribe pain medication safely;
•Understanding how to talk to patients about their health goals;
•Matching those goals to realistic medical outcomes;
•Understanding the health-care system beyond the hospital so that they are able to help patients get the help they need from other sources of community support once they are discharged.
Meier said the debate over health care during last year's health-care overhaul was dominated by companies that make a profit from health care.
She said people could speak up to make changes more in line with their needs.
But they don't realize their power, Meier said.
"All politics are local, and all health care is local," she said.
pgarber@wsjournal.com
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