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Fixin' Healthcare

Saturday, October 31, 2009

The Uninformed Are The Last To Know

To say that society and government failed to protect health in America might not be fair but it is accurate. It might not be fair because a series of policy decisions created and enlarged a medical care system with the intention to protect health. Chief among these are The National Institutes of Health, Medicare, Medicaid and the health manpower acts of the 1970s. The consequences are a population that fears sickness and disease more than they trust the pursuit of good health and large entrenched business enterprises that focus on sickness and disease. It is a mind-set that fails to master the lifestyles and behavior patterns capable of preventing some, if not most, of these diseases. According to World Health Organization data the U.S. ranks below most European countries for health status of the population. However, as European countries adopt elements of the U.S. lifestyle, the incidence of obesity and chronic diseases increases. Americans need better insight and different support to achieve the best health status possible.

There is a story about a man running to catch a bus that left on schedule without him. When he is unsuccessful in his chase, his comment is that he didn't run fast enough. The retort of a bystander is that he didn't start soon enough. Medical care deals with all the alternative ways of getting the man to his destination. Perhaps he will be on time but most likely he will be late. Health care deals with all the ways of getting the man on that bus including starting sooner and the capacity to run faster. On time and ready to go or late and trying to catch up; those are lifestyles. In the book Watership Down, among the rabbit warren kept to provide food, the rabbits were the last to know.

H1N1 Influenza Immunization

H1N1 influenza gets our priorities straight for immunization. Those of us over 50 years old appear to have a relative immunity probably from past exposure to a related virus. The severe H1N1 infections are appearing in children and pregnant women, therefore, they are first priority for immunization. They should always be first priority for immunization. Immunization protects against infection and it breaks the cycle of spreading the infection. Children are the ones moving around and spreading an infection, not old people.

Friday, October 30, 2009

Balance and Moderation

Medical care and health care are two different and related activities with the same goal but different objectives and each uses different processes to achieve their objectives. The central focus of medical care is illness, disease and injury. Medical care professionals dispense services that diagnosis and treat illness, disease and injury with the intent to relieve these conditions and restore the best health possible. The essence of health care is lifestyle based upon education, art, belief systems, values, religion and spiritual life. Health care professionals at their best are educators with an appreciation of art who contribute to the enrichment of spiritual life with the intent to promote, maintain and enhance the best health status possible. Together, medical care and health care comprise the health system and, currently, they are out of balance. The result is many more people seeking medical care than need be. The most effective way to reform the health system and improve health status in the United States is to elevate and enhance healthy lifestyle and embed it in every institution of each community.

Wednesday, October 28, 2009

A Quest For Good Health

The thought never occurred to me to do my time and peacefully ride off into the sunset. As I look back upon my career, it evolved in stages from medical care to health care to health with almost five decades devoted to study, hands on experience and thought about the different stages. It began as a quest for cures of diseases and slowly became a quest for good health. Step by step over many years I learned firsthand the vast difference between the two quests, as well as the important role of human behavior in sickness and health. Central to this change of perspective are some hard earned observations that may appear obvious, perhaps even simple, but I believe they are basic and often overlooked.

These observations define health as the functional capacity of people and society; a health care system consists of health care and medical care; health care is the means to achieve the best health status possible for the individual and the community; medical care is the diagnosis and treatment of illness, disease and injury; if an effort called reform serves only to increase what transpired in the past, it is not reform; it is better to be fit and well than sick and injured; the greatest and most valuable contribution to a long and productive life is good health; lifestyle is everything that transpires each day in a person's life and daily life is the greatest influence upon health status; it is possible to alter daily life with knowledge, effort and determination but most people need assistance to do so; there are many different forms of assistance but the most important are moral, group and community support; the best health status possible (optimum) cannot be achieved easily, if at all, by treating illness, disease and injury, it is best to avoid them. Survival is an art form.

Tuesday, October 27, 2009


Retirement is a concept whose meaning has eluded me. Is it a certain age, the last phase of life, a decrease in functional ability, a group of activities, no need for gainful employment, a different place of residence, mental and/or physical sanctuary, a period of change or some combination of all of the above? My mother believed in retirement but I think it just overtook and overwhelmed my father. They sold the house, packed their bags and returned to the South from the Midwest. Mother felt she was home and did what she always did while my father felt he was on the sidelines and struggled to find something he wanted to do. She lived thirty years and he died within ten years. My wife is a nurse but she was last employed as a nurse thirty-eight years ago, Judging by her activities I would say she retired about the time the children left for college but they remain her primary focus and she stays busy.

A few friends and colleagues my age continue to work full-time but most have stopped and they are busy with various activities, some related to their previously chosen professions. Some retired faculty continue part-time teaching and counseling or special projects. Few retired physicians continue to see patients part-time. The expenses of licensing and insurance are too high, not to mention the administrative hassle they retired to leave behind. There is a clinic on Hilton Head Island, S.C. that makes it possible for retired physicians to provide voluntary care for poor patients. I read about a retired physician in New York state who wanted to work part-time free to serve the poor but the clinic where he previously worked closed due to lack of funds and there was no replacement facility (Peter Applebome, Giving Away Medical Care Isn't Easy, New York Times, 2/18/09).

Monday, October 26, 2009

A Medical Odyssey

I am a seventy year old man who entered medical school in August 1960. My life includes being a son, brother, friend, husband, father, medical student, resident physician, U.S. Public Health Service officer at the National Center for Disease Control and Prevention (NCDC), postdoctoral fellow, faculty member in Departments of Internal Medicine at three universities, medical school dean, university academic vice president and provost, interim president of two universities and, currently, practicing physician. This is my story about personal involvement in medical care, health care and health during the past fifty years. I call it an odyssey defined as an epic journey of special significance to the traveler because the experience contributed to insight and wisdom about life and health.

If optimum health status is the desired main stream for society, then medical care is the default position for illness, disease and injury. The biggest health problem for the United States and possibly the bigest problem of any kind is a population that fears illness, disease and injury more than they understand or pursue optimum health. The status quo aggravates the problem and the concept for health care reform, as well as every proposal from Congress and the Administration are more of the same.

Not Without Honor

(Adapted from Shakespeare by W. Marcus Newberry)
Friends, Americans, patients, lend me your ears:
I come to praise medical care, not to bury it.
The evil in society is amplified and repeated;
The good often retreats from high expectations;
So let it be with medical care. The noble body politic
Has told you medical care is too costly:
If it is so, it is a grievous fault,
And grievously medical care answers for it.
(Here under leave of the body politic and the rest-
For the body politic are honorable people;
So are they all, all honorable people)-
I come to speak in medical care's dark hour.
The practice of medicine has served me well:
But the body politic says it is too costly;
And the body politic is composed of honorable people.
Medical care has relieved many physical ills,
Bringing comfort to society's members:
Did this in medical care seem too costly?
When that the sick had cried, medical care agonized.
Affluence should be made of sterner stuff:
Yet the body politic says medical care is too costly;
And the body politic is composed of honorable people.
You all did see that in the halls of government
Diseases are given costly crowns,
And health is forsaken: what nod to cost is this?
Yet the body politic says medical care is too costly;
And, sure, they are honorable people.
I speak not to disprove what the body politic spoke,
But here I am to speak what I do know.
You all did love medical care once, not without cause:
What cause withholds you then to appreciate it now?
O judgment! Thou art fled to brutish beasts,
And people have lost their reason! Bear with me;
My heart is in sympathy with medical care,
But lest I forget,
There is more to good health than medical care.