The Empty Nest

Figuring out who’s responsible for the mess in my house seems a lot easier than trying to pinpoint who’s fixing the mess for people with chronic conditions, and strangely more rewarding….Like trying to decipher who’s responsible for Allen Wilder’s 7-point drop in A1C, 10-point drop in BMI and an 11 point drop in PHQ-9 depression was not easy for one health insurer I talked to this month - apparently his endocrinologist, primary care doctor, cardiologist, therapist and dietary specialist were all in versions of value based contracts paying them for helping get patients to goal, and each argued that the 42-year-old man’s improvements should have been solely attributed to them…but in the end none of them won the argument, and in fact the insurer gave credit to an exercise program. “There’s a ton of gray area around attribution made more interesting and problematic when you have lots of cooks in the kitchen – and sometimes it’s really just the patient’s behavior change,” Sadie Uston, NP, said of the challenges the industry is having with giving credit and attributing a patient’s turnaround to the right clinician or program…

I would argue attribution is a whole lot easier at home as a parent – I mean, lets face it, we have a lot of experience, partly because kids can be dummies, easily leaving a trail to who’s done what. Last month, as our youngest kid and final one set to leave the nest for college, I found a pair of dirty Spaulding socks in our fridge, two containers of OJ in the shower and an empty tank of gas in my Volkswagen. Figuring out who was responsible was easier than a pillow fight with a 2-year-old — it took seconds, especially when I saw the stack of Arnold Palmer cans next to the recycling bin – “wait,” Tommy said, “you want the cans ‘inside’ the bin?” His trail of evidence was clearer than Reagan National’s runway lights but his Tsunami-like departure was also bitter sweet as it leaves our nest empty. Now I miss the mess…the strewn boxes, balls, bikes, and clothes. The chaos…particularly because it always came with moments like these when you realized the kids could surprise you and make you laugh—and entertain themselves. They just needed encouragement to just figure out stuff on their own and make up their own way, even if it’s a bit messy - perhaps like Allen Wilder who seemed to have an army of clinical support but got to goal mostly by picking himself up, moving his body, and getting help from a retired gym teacher.

Maybe the healthcare industry could take a cue from some parental attribution strategies – said one mom of 4, Maggie Lu of Buffalo, “I don’t divide up allowances – I don’t even give them – if you keep it clean, pick it up, fix something you broke or solve something on your own…then you get to keep eating my food and living in my house.” Touché Maggie Lu. Touché.