What Robert Redford and Chronic Disease Management have in common…

Jane Calligeros, CEO CDM Plus

If you are a patient living with a chronic condition or a health care provider, you have more in common with Robert Redford than you think.  This week I wanted to write something for all the Robert Redford fans out there, myself included.  This is your official spoiler alert warning if you haven’t seen the film ‘All is Lost’.  The movie is set in the middle of the Indian Ocean and Robert Redford’s character is nameless, alone, and on a boat that is sinking.  You’ve got to love a movie that gets you from the beginning.  As the title suggests his situation is dire and as the film begins you connect with Robert Redford immediately as he narrates with what may be his final words:

“I’m sorry. I know that means little at this point, but I am. I tried. I think you would all agree that I tried. To be true, to be strong, to be kind, to love, to be right, but I wasn’t. And I know you knew this, in each of your ways. And I am sorry. All is lost here, except for soul and body, that is what’s left of it, and a half day’s ration. It’s inexcusable really, I know that now. How it could have taken this long to admit that, I’m not sure, but it did. I fought to the end. I’m not sure what that is worth but know that I did. I’ve always hoped for more for you all. I will miss you. I’m sorry.”

What? Where is he going? How did he get here? Why is he alone? Is this the end? Yes? No? Maybe? We glimpse what is and journey back to what could have been.  The journey, the struggle and what we hope will be his triumph against all odds.  The film then takes back to 8 days earlier where things start to go wrong.  He wakes to

find the boat is taking on water and after a floating shipping container collided with his boat and has ripped a hole in the hull.  We watch as he slowly makes repairs the boat, removes water from the cabin and makes assesses his remaining resources.  ‘Great he’s going to make it!’  I think but my mind goes back to his opening words.  When he goes to fix the antenna for the radio he sees a storm approaching.  The storm is severe.  ‘This is it.  This is the moment he loses everything.’  But I’m wrong.  The boat capsizes, he is thrown overboard and the mast snaps off the boat.  The boat sustains irreparable damage and we watch as he just keeps on going.  He abandons the sinking ship and is on the life raft where we think he is safe.  Again, my mind tracks back to the beginning of the movie.  He can’t be safe.  Something else must happen to him.  But hasn’t he endured enough?  We watch him, blow after blow get back up.  We compare his actions to our own.  What would I have done?  Would I get back up?

Great story, but what does this have to do with Chronic Disease Management?  Our Man is alone (Redford’s character) and besides the opening lines the film has no other dialogue and there are no other actors.  The character remains nameless throughout the film and it is only in the closing credits that ‘Our Man’ appears as Robert Redford’s character. In primary health care, most clinics have on average around 4,000 active patients with half of these having a chronic condition.  That’s 2,000 patients we are supposedly actively managing long term care for.  Working in primary health care for almost a decade I can tell you we aren’t anywhere near to managing that many patients.  Each of these 2,000 patients would require a Care Plan appointment and a Care Plan Review appointment in a 12 month period, which means you would need 4,000 appointments for the patients with chronic conditions which means each clinic should be completing close to 17 Care Plan/Care Plan review appointments per day, which we aren’t.

Our patients with chronic condition are Robert Redford’s character and their health and well being is the boat they are sailing through the ocean of life.  Imagine 2,000 patients each on their own boat, in the middle of the ocean.  Clear skies and smooth sailing for some patients, while others sustain life threatening damage from dark skies and storms.  Are our patients with chronic conditions nameless?  Do our patients become known by the chronic condition on a reminder list that we need to manage and monitor?  How many patients have missed a Chronic Disease Management appointment and present a week or two later after being discharged from hospital after a stroke or heart attack?  Did we miss our patient signalling and waving for help using flares?

As a health care provider in primary health care looking out into the ocean at all our patient’s boats, it can be daunting.  Where do we even start?  Is what we are doing with patients even making a difference?  Are we the patient’s life raft?  Yes, we are.  But I also believe that as health care providers, we are the ports that the patients need to frequent at regular intervals: to make repairs, gather provisions, check our course and weather predictions.  Robert Redford’s character is an expert sailor but most of our patients are not.  We need to equip our patients with the skills and resources they need to withstand any storm and prevent possible complications from their conditions.  There is a line from the trailer that rings true for every person “A man has only himself…and his will to survive”.  We need to provide patients with self-management skills to identify possible signs of bad weather, how to navigate and adjust course and continue sailing toward clear blue skies.