Careful and Kind: Talking with Dr. Victor Montori

Victor Montori, MD, MSc, works at the Mayo Clinic in Minnesota as a diabetes doctor. He graduated medical school in his hometown of Lima, Perú, and completed postgraduate training at Mayo Clinic in the U.S. and at McMaster University in Canada. Considered a “a patient’s doctor,”, Montori received the Karis Award, a patient-nominated recognition for his compassionate care. A researcher in the science of patient-centered care, Montori and his colleagues have authored over 500 research articles. At 39, he became a Professor of Medicine. Today, Victor is one of the most highly cited clinical researchers in the world. 

In 2016, Victor founded The Patient Revolution, a nonprofit organization to transform industrial healthcare into careful and kind patient care for all. And here on the Patient Revolution blog, we're talking with Victor about the origin, implementation, and overarching aims of the Patient Revolution.

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Q.  Dr. Montori, thanks for chatting with us today.  Could you introduce yourself and share a bit about your involvement with The Patient Revolution?

A.  I am Victor Montori, diabetes doctor and professor of medicine at Mayo Clinic in Rochester, MN, USA. With friends and colleagues I research patient-centered care and in 2016 founded the Patient Revolution. Today, I chair its board.

Q.  What does The Patient Revolution mean to you?

A.  It is a grassroots effort to upend healthcare, to take it from an industrial machine to a human system of careful and kind care for all. At the system level, healthcare must become accountable to the patient and support the front line of care; it is not about the payers or investors, it is about the patient. At the level of care, the system needs to care always not by accident, and avoid being cruel. Both can be achieved by noticing patients, seeing them — they biology and their biography, the content and context of their situation — in high definition, by treating each person kindly as one of our own, and by responding scientifically and carefully to their situation. The system can support this difficult work by removing from care environments distractions set in place to achieve industrial goals (like documentation and billing routines) and by creating the opportunity for unhurried encounters in which care can flow without friction, elegantly.

None of this will be possible if what animates the healthcare system is greed. Rather we need to build patient care on solidarity, on the notion that we are on the same boat, on the idea that collaboration is better than competition, and on the recognition that the fate of our human adventure depends on our common fate. These are fundamental changes, not subject to reform but in need of a revolution. I expect these changes to be brought about about by the organized actions of citizens, patients, and students. A patient revolution. Professionals, many trapped cogs in the machines, will eventually follow.

Q.  How do you see the Patient Revolution next week?  In a year?  Five years from now?

A.  As we talk, a book Why We Revolt, and the first medical student chapter of The Patient Revolution are coming together. Activities in communities and in clinical encounters, and work to develop the basics of the movement represent our current reality and urgency. I don’t think we will be much further in a year - I expect many more people will be aware of our work, will have read the book, and will have formed local citizen chapters. In five years, i would expect to see that our language and the actions it should inspire will be noticeable as new care systems and experiences intentionally bloom everywhere. Change will become unstoppable. Within ten years, I would want to see most people receiving care in a dramatically different system, one that is careful and kind.
 
Q.  How can clinicians get involved in helping create careful and kind care?

A.  At the frontline, clinicians can fight their own sense of impotence and believe in a better practice. They should reflect on love in their practice, work with their colleagues to have time to reflect and dialogue making their practice deliberately elegant. They should engage with frontline and support staff to ensure every patient is noticed, that everyone is fully present in every interaction, and that the patient’s needs are first in everyone’s priorities. They should forgo actions that take their time and energy but only produce income to them without benefit to the patient. Instead, they should work to reduce the healthcare footprint they, their care, and their system imposes on people’s lives. And they should be more vocal - in their practice, in their community, on social and regular media, in the political process, and armed with a stronger and collective voice, one that perhaps is still trusted, clinicians must tell their stories and invent new ways of imagining care, ways that turn away from industrial healthcare and toward patient care.

Q.  How can patients make a difference in this efforts towards careful and kind care?

A.  I always hesitate to ask patients to do more. As we fall ill, what we want and need is to wrapped in care and love to help us heal, of if incurable, to help us adapt and thrive. We need strong relationships to fall back on when we experience adverse outcomes, and a community to lift us up when we are in need of recovery and regeneration. But, because we have developed a sense of what the system can do, patients can also give powerful testimony, tell stories of wonderful care, even when surprising and almost accidental, and of incidental cruelty. Patients can also tell us stories of what happens in their lives, the consequences of the industrialization of care, and shine light on the opportunities for innovation that exist when we focus on their care, and not on the business opportunities set up by payers and investors.

Those who have enough of their health must speak up and motivate others to join, their stories reminding the rest of the amazing transformations we can accomplish when we collaborate and we stop seeing the realities of today as immutable. Movements have a way of collapsing under their own weight, of becoming focused on their own importance - patients will keep this movement’s momentum forward, its intentions honest, its message coherent. I believe the revolution will be led and powered by patients, by citizens, not by professionals. I believe we will prevail.

Are you interested in joining the Revolution?  You can sign up for our newsletter here and receive the latest from the Patient Revolution team every month.  You can also share your thoughts over at the Patient Revolution Facebook page or on Twitter, tagging @patientrev in your reply.  And for more from Dr. Montori, you can follow him on Twitter @vmontori.