Health:The Crititcal Piece of Reform

Health: The Critical Piece of Reform

Couldn't agree more that prevention needs to be a vital part of health systems. If you have a suggestion for which health system has succeeded best with it, would love to see it. But the VA and Kaiser systems have done a far better job on promoting health of its members than others. Haven't seen any that do it spectacularly well...   Atul Gawande, MD

 Dr. Gawande:

Thank you for your considered response to my blog article: No, You Can’t Get There From Here.

However, disease prevention and the promotion of health will never come from care-based delivery systems whose financial viability depends on diagnosing and treating disease.

In fact, even if they did, their primary tactic of patient education just does not work. Almost all, if not all, people know that smoking is bad for their health, that unprotected sex may result in AIDS, that diet and lack of exercise cause obesity, diabetes and heart disease and death. Yet, sadly, it does not change the behavior of most.

We live in a contradictory world, where the scientific evidence is convincing but the corporate influence (advertising, product placement, lobbying, etc.) is overwhelming.

Historically, most of the major advances in population health came from public health policy initiatives such as improved sanitation, plumbing, smoking bans, seatbelt laws, etc., and not from medical disease ‘cures.’  To believe otherwise now, to discuss national health plans and unified payers or, what should most accurately be called Health Care Finance Reform, as the fix to this pandemic health crisis is both misguided and dangerous. It is treating the symptom and not the cause.

I agree that we need to address the symptoms of costs and access, and I look forward to the inception of national health insurance that includes wellness care and incentives to promote subscribers’ health.

However, the reason I write is to urge you, and other people of influence, to change the dialogue from health care finance reform to public policy discussions to dramatically alter the course of this deadly health crisis.

Much like the pressures brought to bear on the auto industry to make cars safer, we need to exert similar pressures, enact legislation and add taxes (among other measures) to limit access to, and availability of, cigarettes, alcohol, junk food and fast food restaurants; pushing people towards healthier choices.

There are many simple steps that can be taken. As Michael Pollan and others have suggested, the government can subsidize and redefine real and healthy foods. Non-foods would be taxed; at one and the same time creating a subtle awareness of food choices,  financial incentives to buy healthier foods, and tax revenue to support other health initiatives.

We need to limit, or outright ban, political lobbying by pharmaceutical companies. We need to immediately ban direct to consumer advertising of drugs and the associated disease mongering.

There is so much we can do if we stay focused on the right goals.

Thank you again for your time.

Peter D. May, DC CCWP

Words of Wisdom

"It is not that some people have willpower and some don't.

It's that some people are ready to change
and others are not."

(James Gordon)

Crisis Care!

If only we hadn't swallowed him whole!

No, You Can't Get There From Here!

No, You Can't Get There From Here!

Is Atul Gawande, MD , surgeon, Associate Professor at Harvard Medical School, and acclaimed author reading my blog? No.

However, no sooner had I posted “You Can’t Get There From Here,” his article, “Getting There From Here,” appeared in the 01-19-09 issue of The New Yorker.

His article laboriously describes evolutionary 'path-dependent’ patterns that have led to national health plans in other countries and, will hopefully do so here.

He writes: “The overarching goal of health-care reform is to establish a system that has three basic attributes. It should leave no one uncovered—medical debt must disappear as a cause of personal bankruptcy in America. It should no longer be an economic catastrophe for employers. And it should hold doctors, nurses, hospitals, drug and device companies, and insurers collectively responsible for making care better, safer, and less costly. “

All are noble goals for our disease-care delivery and re-imbursement systems that we can hope to achieve; but, once again, largely misguided, as they have way more to do with the economics of care and re-imbursement, than they do with true health-CARE reform.

Dr. Gawande writes: “American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it. The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy.”

Keep in mind, all of that treatment, at a cost approaching 3 trillion dollars/year, for only 300 million Americans! ($10,000 per person per year, and rising! And, 12 prescriptions per year per person!)

The sheer numbers alone decry a failed medical model for health: failed any way you look at it, in terms of the rapidly increasing numbers of unhealthy and sick adults and children, in terms of the inefficacy of the treatments for them, and, in terms of the never-ending, skyrocketing, bankrupting costs associated with them.

The crisis is not one of care, but rather, a true health crisis because so many of us are so unhealthy.

The fix, the saving of lives and money, is in improved health, not in the care.

Sorry, Dr. Gawande, as I wrote in by blog: “You Can’t Get There From Here.”

You Can't Get There From Here

“You can’t get there from here.”

This classic New England expression defines the essence of America’s health crisis.

We have been misinformed and inculcated with grossly misguided concepts of heath that largely contribute to our being so sick.

We have become so disconnected from our own bodies and our own health that we are lousy caretakers of them; to such an extent, that we have given that responsibility to doctors, hospitals, drug companies and insurance companies. All of whom have a vested interest in our being sick.

We wrongly believe that our bodies are inherently flawed; that bad luck, bad germs or bad genes cause disease. That there is nothing we can do short of run to doctors for tests, drugs and surgeries.

Sadly, we believe that screening for diseases is prevention and wellness care.

And, tragically we believe that medical care and treatment equates with health.

Our perceptions about health are so misguided that most people either struggle with, or don’t know, the answers to the most basic questions.

a. What is health?

b. Where does health come from?

c. What is the only thing that ever heals you?

d. If you are on a medication to control something (cholesterol, blood pressure, etc)

…are you: A: healthy? Or, B: still sick, but medicated?

So, it is true. “You can’t get there from here.” We cannot become healthy with our current misconceptions of health.

After all, to achieve any goal, you need to know what it is. And, the more specific your definition is, the greater your chance of success.

In my opinion, there are 4 basic requirements to achieve optimal health:

1. Have a precise working definition and understanding of what health is.

2. Take personal responsibility for your own health.

3. Make a commitment to your own health, as a top priority lifetime lifestyle goal.

4. Make the effort to work at it a little bit every day.

CLINICAL PEARLS -2 Patient Research

Clinical Pearls-2

Patient research…

While remaining healthy is the goal, we, or someone we love, may, at some time, require medical care. Having a primary medical physician whom you can trust and communicate with, freely and openly, is invaluable.

The NYTimes article, In Search of a Good Doctor, by Pauline Chen, MD, provides valuable information for researching physicians and hospitals, as follows:

Researching Physicians and Hospitals:

1. State boards of medicine: State medical boards can provide information regarding a doctor’s licensure, training and history of disciplinary action.

• To locate state boards, the American Medical Association provides a listing. (www.ama-assn.org/ama/pub/category/2645.html)

2. The American Board of Medical Specialties (www.abms.org/): The A.B.M.S. has a doctor-finder function that will pull up a physician’s board certification.

3. The Agency for Healthcare Research and Quality (www.talkingquality.gov/compendium/index.html) : The A.H.R.Q. has compiled health care “report cards” that provide comparative information on the quality of health plans, hospitals, medical groups, individual physicians, nursing homes and other providers of care.

4. The United States Department of Health and Human Services, Hospital Compare (www.hospitalcompare.hhs.gov):
This site provides information from participating hospitals on how well those hospitals care for patients with certain medical conditions or surgical procedures. Also included are the results from patient surveys on quality of care during hospital stays.
--------------------------------------------
As for researching conditions, the article suggests going to patient advocacy group sites for condition specific information. I do believe some valuable information may be gleaned from these sites. However, bear in mind that many, if not all, of the patient advocacy groups are funded by the pharmaceutical and medical device manufacturers and act as an extension of their marketing efforts: “what appears as awareness-raising activities are really designed to change awareness in ways that serve the marketing needs of their latest products (Selling Sickness by Ray Moynihan).”

"The best defense is a good offense."
Commit to, and work at, staying healthy throughout your life!

CLINICAL PEARLS-1 Dr.Communication

Clinical Pearls-1

Dr. Communication...

Picking up where my prior entry (In Doctors We Trust) left off...

“a healthy doctor-patient relationship... requires that patients come to the relationship educated about their doctors, their illnesses and their treatment.”

Based on my experience and my readings, I have assembled a list of 'critical questions' that patients need to ask to become informed health care consumers and assure, as best possible, the best care possible.

Please note this list may not be complete, and I will add to it as I think of new and better questions. In addition, if you have any suggestions, please feel free to leave them as 'comments.'

List of Patient Questions Prior to Submitting to
any Surgery, Diagnostic Procedures,Treatment or Drugs

1. Is this surgery-procedure-drug absolutely necessary, and what could happen to me if I choose to forego it?

2. What alternative treatment options are there?

3. What are the risks verses benefits of this surgery/procedure/drug?
a. What is the risk of infection from surgery or invasive procedures?
b. What are the potential complications I could face?
c. How will you handle this case if complications arise?
d. What are the chances of death from the procedure itself and from anesthesia?
e. Do I have any other health factors that increase my risks?

4. What outcome to you expect?
a. What is the immediate outcome anticipated
b. What is the 6 month/ 1year-3 year-5 year prognosis?
c. What are the likely long term effects of this procedure?

5. Are you board certified in this surgical/diagnostic procedure?
a. How many times have you performed this same procedure?
b. Do you perform this procedure on a regular basis?
c. Statistically, how many have had the best outcome that you anticipated?
d. Could you give me the name of a colleague as a personal and professional reference?

6. Will this surgery/procedure be performed in a hospital-OR, or in another setting?

7. What type of follow-up is there with you, personally?
a. What other type(s) of follow-up will there be, and with whom?
b. Is there any associated re-hab in another facility? Where? With whom?

8. How much will this procedure cost? What is included?
a. Will there be any surgical assistants? Are those costs included?
b. If complications arise, are the costs of follow-up care included?
c. Do you and everyone on your team accept my insurance?
d. Are there any other fees or, are there fees not covered by my insurance?

9. What are my pre-surgical and post-surgical responsibilities and roles as the patient?

10. And then, get a second opinion!