HEALTHCARE: Reform the PARADIGM

From an article in the Pittsburgh Post-Gazette 10/11/2009. Sunday Forum: Suck it up, America: We have become a nation of whining hypochondriacs, and the only way to fix a broken health-care system is for all of us to get a grip, says DR. THOMAS A. DOYLE

The human body is exquisitely talented at healing. If bodies didn’t heal by themselves, we’d be up the creek. Even in an intensive care unit, with our most advanced techniques applied, all we’re really doing is optimizing the conditions under which natural healing can occur.

“Our best medicines are Tincture of Time and Elixir of Neglect.” Taking drugs for things that go away on their own is rarely helpful and often harmful.

We’ve become a nation of hypochondriacs. Every sneeze is swine flu, every headache a tumor. And at great expense, we deliver fantastically prompt, thorough and largely unnecessary care.

Read more:

http://www.post-gazette.com/pg/09284/1004304-109.stm#ixzz0UzeQAZNR

Although I agree with the good Dr.’s points, I want to chime in with a broader perspective from someone who is no longer part of the industry.

I resent the tone of his article. He is critical of his patients for choosing to follow precisely the dictates of the industry that cripples them. It is the same industry to which he is indebted — in more ways than one.

If you take his reflections one level deeper you will see the source of his complaint; the shift of medical empowerment from the individual to the institution. This reflects a larger trend which is the demise of Community and the ascendancy of the Corporation. We are a society quickly being molded to depend less and less upon each other.

Not too long ago, the primary source of advice on medical matters was people with whom you had connection. In order to generate money, that focus had to shift away from people and on to a product. The winner was the corporation that could best package and sell the cure. Your neighbor and Aunt were replaced by “commercials”.

Once medicine became Big Business, economic forces dictated that anecdotal, traditional, native, and folk medicine, all including natural remedies, be pushed to the side, and most importantly, debunked and derided as “non-scientific”. This, in fact, occurred.

In that vacuum, campaigns were undertaken to “educate” the public on just how many little things can go wrong with these fragile bodies. Fortunately, science has a cure, and here’s where you can buy it!

Corporatized, institutionalized medical care became a primary income source for millions of people in thousands of spin-offs. It spawned a tiered system that  the medical “consumer” could explore from product to  procedure for the rest of their lives.

Economics stepped in to make sure each level of illness you attained, or “cure” made available to you had with it a corresponding product or procedure, commensurate in expense with the percieved complexity of it and its handler.

Many, many people have been helped. But today, it’s all breaking down under its own weight. Something…MANY things are not working.

Doctor Doyle says:  “Health care costs too much in our country because we deliver too much health care. We deliver too much because we demand too much. And we demand it for all the wrong reasons. We’re turning into a nation of anxious wimps.”

We’re only about 50 years from the time when hospitals were considered places you go to when you died. I’m 58 and when I was a kid, growing up in Brooklyn in the 1950’s the last resort was the doctor (who made HOUSE CALLS!); the Final resort was the Hospital and the Conclusion, the newly emerging Funeral Home!

How were medical problems handled? First, by the family and then, the extended family. Every folk remedy in the book was used BEFORE a Dr. was contacted. The primary, time-tested and NATURAL methods were completely exhausted before a trained professional was called (and paid!). Preliminary care had $0 associated with it, only time and concern. Though a very big factor in the effectiveness of this approach was proximity — relatives were geographically available, which is not the case today.

And then SCIENCE took control. Granted, it could have been partially in response to the societal trend of the fragmentation of the extended family. Still, science costs money. That means investors. Investors require a return on their investment. That means profit, and profit comes from getting people to buy something. This is the American Way.

In order to do that you had to shift the source of health care from the family to the institution, which now was housing all those Paid Scientists. You had to raise the funds to keep them going.

Naturally, you wanted them to be in comfort.  And yourself, of course, so a market had to be created, the size of which was determined by the level of comfort you wished to attain.

Sometimes it’s hard to discern for whose comfort our self-perpetuating  health care system is designed.

Did you know the when the image of the hospital as a place people went to die changed? Right around the time the AMA mandated newborn deliveries to be taken out of the home or doctor’s office and into the hospital. All of a sudden, hospitals became places where people were born. In marketing, perception is everything!

What happened then was simply the compounding effect of the Very Human trait of protecting one’s territory. In this case, profits. This was not an accident. The guiding philosophy of the Industry now was to get control of every aspect of an individual’s care so profits would accrue so more things could be devised to keep health care out of the control of the individual, thereby generating even more profit. It’s a form of mystery building.

Even Obama’s best efforts are based on perpetuating the system as it stands. That system is literally killing us by killing our health-care providers.

Doctor  Doyle is basically sharing that he expends a significant amount of  his life energies  taking action against those innumerable ills that befall the human being whose health is, in medical parlance, WNL; within normal limits.

These ailments once were handled by their peers in the community, with inexpensive remedies, easily obtained. Now, they’re in this Doctor’s ER.

Perhaps the Doctor doesn’t see that he’s fulfilling the role he was meant to play: He’s there to service the market that was created to support the industry that helps him to act like an ER Physician. He is fulfilling his role as “Holder of the Mystery”, but it’s not his only role.

The grave both the Doctor and the common folk are being herded into is not one they dug themselves. Here’s how it works. Going back to the problem’s Genesis, let’s visit the American Medical Association (from: http://www.alternet.org/story/81659/)

When George H. Simmons began in 1899 what became a twenty-five-year reign as head of the AMA, it was a weak organization with little money and little respect from the general public. The advertising revenue from the medical journal was a paltry $34,000 per year. Simmons came up with the idea to transform the AMA into a big business by granting the AMA’s “seal of approval” to certain drug companies that placed large and frequent ads in JAMA and its various affiliate publications. By 1903, advertising revenue increased substantially, to $89,000, and by 1909, JAMA was making $150,000 per year. In 1900, the AMA had only 8,000 members, but by 1910, it had more than 70,000. This substantial increase in advertising revenue and membership was not the result of new effective medical treatments, for there were virtually no medical treatments from this era that were effective enough to be used by doctors today or even just a couple of decades later.

(Emphasis mine)

The economic tie-in is unavoidable, even if you choose to think the industry has regulated itself in the years that have passed out of altruism.  We’ve eliminated “Quack Cures” haven’t we?

Not if you define them as treatments/medicines that do no more than provide the illusion you’re doing something when all that’s happening is time passes. That’s a point of the Dr.’s article, is it not? I interpreted that as what he was saying about Intensive Care Units.

American industry is defined by innovation – whether you need it or not. Innovation is nothing without marketing. You’ve got to find your niche because it IS a competitive world out there. If you don’t find your niche – a vehicle to help sell what you have to offer – then create one. That, too is the American way and it applies to Doctors as well.

Doctors must perpetuate the illusion that they are the final arbiters when it comes to that which ails you. In order to do that, they have to support the illusion that the over-the-counter drugs sold you to relieve your pain and suffering actually work; to a point. From that point on their job is to bring you up to the next tier of therapies.

Most typically, that involves pharmaceuticals. An MD in private practice the other day told me he sees about 40 patients each ten hour day, and that’s not packed. When I asked what do you do, he answered me in one word, “Prescribe.”

If you get worse, it’s up to the next tier you go. Typically that involves some sort of diagnostic process which then leads to the next tier, invasive procedures.

Essentially, Doctor Doyle sharing his frustration about his other role, that of Gatekeeper. In the absence of Aunt Lucy to advise, in the failure of the OTC meds to take care of ALL those nagging little symptoms, and not being able to plan the timing of her freak-out, the woman seeks out the nearest next tier, which is him.

So much of it is about the need for human contact.  Study after study shows most ER visits are driven by the need for human advice and caring. But the health care providers can’t do that; because the system asks them to find something to cure that is curable by something that generates money because those are the tools they’re given and trained to use.

These tools fall in to the broad categories of drugs and surgery; the primary approaches embraced by the AMA over Homeopathic, Chiropractic or Osteopathic philosophies. Is it too hard to see how those competitors to Allopathic Medicine may never have gained traction because they simply didn’t have the marketing power behind them the AMA did?

This is not out of step with history. Christianity as a religion was circling the drain until Paul of Tarsus, Master Promoter, came along.

Perhaps the saddest part of the whole dynamic is that Physicians enter their profession mired in debt. There’s only one way to get out of it and that’s to become even more deeply entrenched in the system. Of course Physicians are still altruistic but because the industry that trained them was molded by economics, without even realizing it, that thread runs through everything they do. For some, it’s more like a cable.

It’s no different for you  Dr. Doyle, so quit your own whining, and please don’t try to lay the blame at the patient’s feet. That is taking a superior attitude. Remember, you’re just a Gatekeeper.

I was a Paramedic, a Gatekeeper as well. I know the biz. The only way I got to use my monitors, defibrillators, drugs and therapies (and occasionally save a life!) was to haul Gramma Grinch from the hospital to the nursing home, respond Code 3 to pediatric fevers, and even put drunks in the back of the ambulance to avoid a crowd attacking me for prejudicial treatment: I was commanded to do my job, which more often than not was merely a horizontal taxi service.

That’s the price you pay for being a part of a system that has forced medical care out of the hands of the people and into the computers of the  accountants of the corporations. You are the manifestation of profit, and are beholden to it.

If you’re going to be an activist, Dr. Doyle,I suggest you begin the work there. How can YOU change the paradigm to serve both you and your patients? It’s the paradigm that needs fixing, and you’re in a great position to help do it.

I wish you well!

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4 Responses to “HEALTHCARE: Reform the PARADIGM”

  1. Thomas Doyle Says:

    While your comments have some validity, I think you miss the point of my article. This is not a “blame the patient” statement. This is a “blame the system” statement. I had an epiphany to confirm this recently, when upon returning from Haiti, the first patient I saw in my next shift was a 97 year old lady with dementia who was rushed from a nursing home by ambulance to the ED for “altered mental status”. The American system expects a full work-up (and probable CT scan) at the cost of many thousands of dollars, when her BEST outcome is simply to return to the nursing home. All while healthy young Hatians are dying for lack of five dollars’ worth of antibiotics. We need to explain to people (through extensive education programs) what medicine can and cannot accomplish, and encourage people to take greater personal responsibility for their own health.
    Thank you for your thoughtful consideration of my article.
    Sincerely,
    Tom Doyle

    • firetender Says:

      “We need to explain to people (through extensive education programs) what medicine can and cannot accomplish, and encourage people to take greater personal responsibility for their own health.”

      Thanks for your response, Tom!

      I acknowledge our agreement that the system is the culprit.

      There is, however, a subtle difference in our positions. Knowledge of “What medicine can and can not accomplish” is not enough.

      I see the system (capitalist as well as medico-legal-corporate) as having successfully snatched the average person’s ability to take greater personal responsibility for their own health.

      Thus “explaining to them” will be insufficient unless it is backed up by the establishment of viable alternatives, for example, a Community Resource Center that would refer people to 1st Tier practitioners, or Internet or Other Resources that would help them to navigate through common illnesses.

      I’m simply talking about a center for Common-sense information, because that is where the biggest gap lives. Common Sense was once Folk Sense. We’ve lost most of the Folk Sense. The underlying disease is that we’ve lost connection with each other as a resource.

      In order for that to be restored, the system must take an active part in re-empowering the people to participate in being the first line of their own defense. That means loosening their death-grip on their claims that the substances and procedures they offer are the only way to go. In our belief and awe of that shamanic power, most of us have learned to distrust our own instincts.

      My point, though we are essentially saying the same thing Tom, is the people will need a lot more help than you seem to recognize, and YOU will have to lead the way by example as well as education. How will you empower your patients? That could be a terrific model for others.

      Respectfully,

  2. Thomas Doyle Says:

    Good thoughts… One proposal I have is to create a guide to excellent medical websites, thus disseminating free and accurate medical information more thoroughly. Another model, which would break taboos and probably a few laws or regulations, is to create a site, similar to facebook or other interactive site, which is free yet the practitioners can prescribe medications and give advice for common, simple problems without fear of lawsuit or retribution. The ability to talk (skype, even) to a real doctor or practitioner 24/7, free of charge, might reduce quite a bit of the demand on doctors’ offices and emergency departments, and save the general populace quite a bit of time and money. The problem would be how to pay for it. Unfortunately, the most viable model would be to use advertisement dollars, which of course could introduce bias. But one of the main themes I am trying to espouse is greatly enhanced medical education for everyone, mandatory in schools from an early age. It can only help. This would go a long way to remove the “shamanism” (which isn’t always a bad thing, by the way. That’s how many alternative therapies work, by inspiring confidence in treatments which have dubious scientific value but allow the body to heal on its own).

  3. firetender Says:

    Wonderful stuff, Tom!

    I especially like the part about taboo-breaking!

    If you’re not doing anything, let’s create a site: “Anonymous Advice From the Shamanic Class For Your Health and Happiness So You Regain Control of Your Lives and We Can Focus On Better Things For Everyone’s Future.” (Copyright 2010)

    It would be a “Sue-free Zone” on the internet (perhaps protected by the 1st Amendment?) where Licensed Practitioners of all stripes, such as Doctors, Dentists, Lawyers, Nurses, etc. would be screened for the veracity of their qualifications and then have a password protected account to contribute anonymous advice. The screen would show a Screen Name and Qualifications and Specialty.

    It could include Forums, where the Experts compare notes, take sides or combine their approaches while they show themselves as true Teachers, or sniveling adolescents.

    No ads of any kind. If the people want it, it will get done. I suppose if the infrastructure were designed and an estimated cost assigned to its launch and maintenance for one year, from that a small subscription fee could be determined based on Xthousand subscribers.

    There’s the start of an idea, anyway. The floor is open for Comment!

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