Sunday, August 30, 2009

The Business Model of Health Care

Twitter friend @StaticNrg, a highly empowered Cushing's Syndrome e-patient, sent an article that ends thus:


Our society has decided that provision of certain services is best left to the government and out of the marketplace. It is ridiculous to think of multiple water systems, for example, competing to bring drinking water to individual households. It is equally unthinkable to subject fire departments to the economic dictates of competition: we certainly do not want fire chiefs to be creating more demand for their work. We do not choose to divvy up national defense between competing suppliers of armed services, for obvious reasons. Alternatives to these types of public services just do not fit into the corporate model that works so well for consumer goods and services. They are either too expensive, lacking in overall benefit to the entire populace, or just plain too chaotic.

Should health care be any different? Do we want the consumer-driven marketplace to rule in such a way that untrained, vulnerable individuals can order for themselves expensive medical tests that have no proven benefit and may carry incalculable opportunity costs? Do we want entrepreneurial efforts to increase consumption of highly profitable drugs, regardless of cost and any consideration of what might be best for medical care? Do we want a system that rewards the creation of expensive and profitable services, such as NICUs, without consideration of need? Do we want to continue to witness the compromise of the integrity of basic medical research in the name of profit?

As these questions are framed, the answers are obvious. Clearly, it is necessary to overhaul our health care system so that decisions are made to improve health, not the bottom lines of corporate enterprises. Current issues in health care that politicians debate (universal health insurance, medical malpractice reform, a drug benefit for senior citizens) are important, but dealing with them will constitute mere tinkering with a system that needs more than a patch here and a stitch there. Rather, fundamental assumptions about medicine’s role in our society need to be considered. It is a wonder that we allow such a flawed system to persist. It a greater wonder that the basic question of what health care should be, a business or a social service, is not even on the national agenda.

I thought "MAN that makes sense! Who brought this into our discourse?? I sure hope people listen!"

Then I saw the publication info:
James P. Whalen is a medical doctor and a freelance medical writer living in Oak Park, Illinois. The Independent Review, v. VIII, n. 2, Fall 2003, ISSN 1086-1653, Copyright © 2003, pp. 259–270.

2003. Six years ago! Still makes sense to me.

Saturday, August 8, 2009

Patients, listen up: the power of your attitude

One aspect of patient empowerment is taking responsibility for your/our situations. In the new discipline of participatory medicine we talk about collaborative partnership with our providers (docs, nurses, all the professionals).

One doc, Stanley Feld, talks about "physicians as coaches, patients as players." Another well-known hotshot, Fast Company's "doctor of the future" Jay Parkinson, talks about being "the CEO" of your body - the one who makes the strategic decisions and assembles the team. (The CEO doesn't have the required expertise, but is responsible for acquiring it. The experts advise, but the CEO is responsible for using the advice.)

And in my view, one aspect of this is being responsible for the mental aspect: our attitude.

This comes to mind because tonight I ran across this, a journal entry from the start of my treatment:


If this question's new to you, think about it. When I first got the diagnosis, the cancer sure had me: I was at its mercy. Every change in my outlook came from outside me: it was something that seemed to happen to me, something over which I had no control.

I have a mental image for 'the cancer has me.' In that image, the cancer is like a big dog with a chew toy (me) in its jaws, shaking the daylights out of it and tossing it around.

The pivotal change came when I chose to get in action and do whatever I could, learn whatever I could. Mind you, who am I to know how to fight a cancer?? Do I know anything about the biology of cancer? No. But now my outlook is that I have a cancer in my life, and I'm doing what I can to manage it .... and I'm creating new ways to interact with it, beyond what others have thought of. (Your feedback here tells me that.)

I say it's vitally important that YOU realize what a difference this makes. Remember something I said back in February: citing a study, a nurse in my email group said 'If you're actively involved in creating your care, learning everything you can, and finding the best care available, then your outcome automatically moves to above the median.'
Paul Levy posted that on his blog 120 weeks ago. (A bit over two years, though it seems like ten.) His post drew an unhappy comment from someone anonymous:
This is the sort of American positivity that drives me nuts. Unless you're lucky enough to catch it early or have one of the curable ones, cancer will probably kill you in a few years. This is a time to put your affairs in order and do those things you always wanted to before you die, not be all positive and managerial.
Well, we all know how THAT turned out. :-) (Another anonymous commenter responded, "Buzz off, Eeyore.")

In the prolog to my journal I cited Norman Cousins's great book Anatomy of an Illness, which chronicled how he used belly laughs, love, hope and faith in beating an unbeatable stomach cancer. His book starts:

That was thirty years ago, folks. Back then nobody knew the facts that today we call psycho neuro immunology. (Attitude [psych] measurably affects the nervous system [neuro] which measurably affects the immune system [immunology].)

Yes, folks, it's been shown that your attitude can affect your immune system. You gonna take responsibility for that?