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Fixin' Healthcare

Wednesday, November 18, 2009

Discretionary Resources

Strictly speaking, discretionary resources reach beyond basic needs of individuals and society. That does not mean every individual or the society possesses every basic need before designating resources as discretionary. Discretionary resources are highly prized and efforts to create them are a matter of values, judgment and controversy. Once basic needs are believed to be secure and discretionary resources are available critical thinking and behavior change. Too many resources have destroyed enterprises and no civilization yet has withstood the onslaught of prosperity. Discretionary spending places human behavior at risk because it erodes the understanding and value for basic needs. A fraction of the total resources gets more attention than the whole of resources. The risk hinges upon whether the boundary becomes the leading edge for progress as determined by the common good or it becomes self-serving and obscures basic needs and goals.

Sunday, November 15, 2009

Prosperity Is Us

During my lifetime there has occurred in the U.S. wide distribution of resources across the population and the elevation of a substantial portion of the population above the level of basic subsistence. No other nation on earth in history can match the extent of these trends. They are characteristic of the American economy and they have come to shape American society. A broad appeal of American culture is consumerism based upon prosperity and individual freedom of choice. But, prosperity is always uneven and it never seems to be enough to raise all ships or solve all problems. The fear is demand will exceed capacity but the danger is demand will exceed capability.

Saturday, November 14, 2009

Business and Politics

Economic and political systems have prominent places in this story. They are only two components of society but in the American culture economic development and politics are strong forces that exert powerful influence upon the flow and direction of life. They are the instruments of democracy and capitalism. Together, they establish the agenda, set priorities, allocate resource, reinforce each other and expand to control adjacent activities and systems. Economics and politics are tools that influence world view and facilitate prosperity but the influence is not always benign or positive.

Thursday, November 12, 2009

Critical Thinking

Critical thinking evaluates evidence, separates fact from opinion and determines whether cause and effect have been established. The skills for critical thinking can be learned but it requires the disposition and motivation to use them. Anyone involved in patient care can relate how little critical thought patients give to their health status. A 2003 survey of health literacy skills by the Agency for Healthcare Research and Quality (ARHQ) revealed 12 percent of adults were deemed proficient to obtain and use health information to make appropriate health care decisions. An important first step for health care reform would be health education for consumers done in such a way to foster skepticism and critical thinking. It may be the most important step.

Wednesday, November 11, 2009

The Challenge

As progress in the search for cures slows, larger expenditures are required for smaller gains. Increasingly, health problems are stabilized and maintained as chronic diseases treated with multiple drugs, surgeries and medical devices, often all in the same patient. The chronic diseases deteriorate at varying pace and the search for cures becomes a state of constant medical care. While health care reform focuses on maintaining and expanding this situation, the challenge is to develop a conceptual framework for health.

Tuesday, November 10, 2009

Great Expectations

American society and the medical profession place great value on the individual. Individuals seek medical care with a complaint and/or after the onset of sickness, The ethical principle is to do everything possible for the individual. Doing everything possible most often is perceived as more medical care, high technology medical care and specialized medical care. Under conditions of uncertainty and stress, which include sickness, people fall back upon convention and new information is not processed efficiently because it is unclear what information is relevant. During sickness people will fall back upon their ingrained health beliefs and what they want to be true. The increase in chronic diseases for which there are few, if any, cures creates a disconnection between public expectations and the capability of the medical care system.

Sunday, November 08, 2009

Find and Fix

Following World War II large sums of money were spent upon biomedical research. The utilization of the expanding knowledge of science and technology to serve a purpose required a conceptual framework. Society responded by giving precedence to the quest for cures over the quest for health. It was to be proven a lifestyle choice. The quest for cures is channeled through diagnosis and treatment of illness, disease and injury. This created a large and complex medical care system with the responsibility to find the problems and fix them. Without a counterbalancing concept or a systemic process to promote and pursue good health the medical care system with the cooperation and full support of the economic and political systems grew to dominate the public perspective of health. Ideally, sickness would be the exception to good health and sickness would be unusual; however, simultaneous changes in society created increased risk for unhealthy lifestyles and reduced some of the safeguards for health.

Tuesday, November 03, 2009

Recovery and Rhabilitation (R&R)

By definition complex systems are difficult to know and understand. Without interference these systems usually function as expected but occasionally they malfunction or they are injured. The choice to intervene may not be an option but the manner of intervention is always open to question. The human body, the environment, the interaction of the two and health are at the pinnacle of complex systems. Powerful tools provide the means for discovery of increasing amounts of ever finer details about organ systems and biological processes in the human body but the understanding of how these details function together in the intact person is elusive. The technology of the human body exceeds that of medical care and healing depends upon the higher technology. Medical care assists the technology of the human body and there is much to learn about assisting so as to facilitate healing and rehabilitation.