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Fixin' Healthcare

Thursday, December 29, 2005

The Age of Elves

I entered the field of medicine 46 years ago. It seemed to be a more simple time but I was younger. Our objectives were to diagnose and treat sick people. Technology was limited and good diagnosis relied upon the medical history, the physical exam, basic laboratory tests (CBC, urinalysis and electrolytes) and relatively unsophisticated X-ray. Clinical experience and deductive reasoning were valuable assets. Therapeutic modalities were limited, and there was appreciation for the healing and recuperative capabilities of the human body.

It was a time when the best training programs were at the large charity hospitals. To be admitted as a patient to one of these hospitals usually meant being 6+ sick on a 4+ scale. We performed the CBC and urinalysis on the ward. It was before Medicare and Medicaid and rapidly escalating health care costs. Marketing was unheard of and competition was a notion based upon egos (still true today). It was before hospitals became more like luxury hotels and hospital administrators has not yet become CEO's.

I have witnessed many marvelous things in medicine. My collegues constantly amaze me with what they are learning and how they apply that knowledge. There has been rapid development of technology that has vastly increased information about patients and diseases, as well as therapeutic capabilities. The rapid development of technology has been matched by rapid deployment that has occured in a widely distributed fashion without guidance of any health care plan.

The desire to cure disease is an issue with broad appeal that ultimately sustains the health care system and generates substantial resources. However, medicine has become big business. Marketing and business competition have become the norm. The local hospital is one of the largest employers in most communities. National budgets and the economy are heavily influenced by the health care system. And, business interests influence the development and expansion of medical care.

Political support is growing for reform of health system financing. If past history is any judge, reform will come by bits and pieces over time. Reform is made more difficult by the absence of a clearly articulated and widely accepted vision or plan for health care. Goals and priorities are frequently ad hoc and opportunistic. The rapid pace of change under these conditions is often inefficient and not effective.

Common infections that killed so many people 50 years ago such as tuberculosis have been replaced by AIDS and bird flu. Some of the infections of today are created by the advances in suppression of immunity and "superbugs" made resistent by the widespread use of antibiotics. Tuberculosis has reappeared sporadically and in clusters under these conditions. Treatment and cures of early stage cancer has improved tremendously but progress with late stage cancer remains slow. Yet, it is late stage cancer where most of the effort and resources are directed.

With all of the appeal of technology there is failure to recognize the human body as the most complex and sophisticated technology ever encountered. It is difficult to accept that lifestyle is the mechanism by which each individual manages and controls this technology. The human body with proper care and baring unforseen circumstances is capable of amazing things, including the achievement and maintainence of optimum health. Proper care includes daily physical activity, drinking water, eating foods containing the necessary nutrients, adequate sleep, managing stress, avoiding toxins such as cigarette smoke, unecessary medications and addicting drugs and avoiding risky behavior.

The major health issue for America today is not health insurance or insufficient resources, it is lifestyle and a culture that is inappropriately oriented to sickness. It is a matter of perspective and priorities. There will always be people who need medical care but this number can be and should be far less than it is today. Americans have expectations for medical care that are beyond what medical care is capable of at the current stage of development.

Health care is broad and expansive with the goal of achieving and maintaining optimum health. There is a growing body of scientifically verified and reliable information that defines healthy lifestyle and its value to optimum health status. In contrast to medical care there is not a well defined business model for health care. There is financial reward but it comes in the form of savings from medical care and increased creativity and productivity from a healthy population.

It all starts with individual responsibility and community commitment. A culture for health needs to grow and involve everyone in all aspects of community life. There are communities scattered throughout the US and the world that have started this effort.

The Age of Elves has passed and we are well into the Age of Man and Woman. I have great faith that society is at the beginning of an era of improved health status that we did not even dream of back in those days 46 years ago on the wards of Grady Hospital.

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