It never ceases to surprise me how easily our focus is diverted from issues so blatantly obvious they actually consume us.
Daniel Quinn, the author of the widely-acclaimed book, Ishmael, reveals an extraordinary insight in his depiction of the ancient aviator taking the ultimate plunge off the highest cliff in a makeshift flying machine constructed of bark, twigs, twine and feathers. Convinced he's finally succeeded, with great jubilation he delights in the accomplishment of soaring successfully though space.
Yet in reality, the ground is rapidly approaching. Yes he eventually sees expanding detail, for terra firma beneath him is littered with the skeletal remains of those who tried before. Yet our "would be" hero convinces himself to the very end that he only needs to peddle faster. The rest is history, and such may be the case of American healthcare.
While we're bombarded with news, policy, debates and media blitzes about health insurance, HMOs and alternative medicine on a daily basis, we've been led to believe that our ailing healthcare system is actually on the mend.
Yet what is the true value of insurance for all, managed cost or alternative medical choices when the system itself has never evolved to meet the needs of the society it serves?
Some might argue that people are living longer. If you agree, why not take a step back, examine the broader perspective and you will discover that the ground beneath us is rapidly approaching. With expectations of survival well into ones 80s or 90s, have we as a nation seriously considered a dramatic increase in the odds of developing cancer, heart disease, strokes and a host of degenerative conditions.
Is longevity itself any more of an accomplishment than our ancient aviator's free-fall journey? Is it your choice to live with such compromise?
Let's spend a few moments exploring the makeshift craft we call our contemporary medical system. In its rudimentary form, the fundamentals of healthcare are simple to follow. Individuals enter the system only after becoming ill. Now referred to as patients, they subsequently present to physicians who focus on two principal issues: correct diagnosis and the most effective and immediate treatment strategy. After a limited series of short follow ups, the condition is either stabilized or it subsequently worsens. If the situation deteriorates, the patient enters an institution which offers the latest technological advances in a coordinated, cost effective manner. The hospital is basically geared to effectively deal with the immediate problem utilizing a strategy shaped by two opposing forces: quality of care vs. financial constraints imposed by third party payers.
Assuming what is considered a positive outcome, the patient re-enters the loop with the same condition that prompted entry in the first place. Returning to the physician, the patient, now on a host of medicines, continues to endure a chronic illness for which the elusive cure does not exist. And the cycle ensues in a predictable downward spiral.
As a physician focused on whole person care, it's obvious that for individuals facing cardiovascular diseases, chronic lung disease, cancer and diabetes, conditions that are among the leading causes of disability in this nation, something is obviously lacking in our system. For as increasing numbers of people are processed in this loop we call healthcare, the system progressively and predictably fails.
The rationale is amazingly simple. Patients remain dependent on an approach that has evolved into a band-aid application. What we seem to be fostering is dependency without long-term goals rather than providing an opportunity for education that is a critical investment in well-being for two primary reasons.
Essentially, our nation's healthcare system doesn’t adequately meet our needs or expectations. It's time we realize that people are not born with owner's manuals. Education is a fundamental and inseparable component of "salutogenesis," the process of creating or maintaining health. It is our responsibility to ensure our system is designed from the ground up for longstanding success.
- Lifestyle, in many cases is strongly correlated with the health-disease continuum. Extensive scientific literature has clearly established powerful associations for diet, exercise, stress, alcohol, tobacco, environmental toxins and sexual exposure with a host of serious illnesses.
- Taking responsibility and control over one's life directly impacts quality of existence and survival in many cases.
While frustrations exist for patients and healthcare providers alike, it is personally satisfying to know that our hospital and the Commonwealth of Pennsylvania through dedicated research funding is empowering our community with the whole person tools and programs we need to improve quality of life and promote health on many levels. To break the mold takes commitment, perseverance and the courage to assess and reform a troubled system deeply steeped in tradition. The willingness to dream, to think out of the box and to explore the fundamental premises upon which our present-day healthcare exists, is certain to impact the medicine of the future. It’s reassuring to know that instead of just peddling faster, we're actually making progress in keeping the ground from rapidly approaching--Mind Over Matter!
© 2000 Barry Bittman,
MD all rights reserved