Saturday, March 31, 2012

Naive, Childlike, and Wholly Unrealistic

Let's take a trip together to a hypothetical United States of the future where the health care industry's* prime interest lies in prevention versus treatment of illness.

In this election year, with my irrational hope of meaningful health care reform under the Affordable Care Act, I've been thinking a lot about what health care would look like if health promotion (a skill not usually emphasized by the leaders of our medical-industrial complex) were as highly valued as illness treatment.

I realize my fictional health promotion system will never come to pass. I know that heroic fire-quenching action with its swift, tangible gratification is usually chosen by human beings over the weak satisfaction of making something not happen. But, then again, fantasies help us set goals. So here's my dreamy, wacky, silly, naive, childlike, unrealistic list of what would happen in a reformed U.S. health promotion system, in no particular order, all drawn from what I have myself observed in my 30 years in health care:

  • No one would wait until after their coronary artery bypass graft operation or their heart attack to get a referral to cardiac rehabilitation. Ditto for pulmonary and post-cancer rehabilitation.  And how about we start a rehabilitation program for everyone, not just those with certain diseases?  These programs work for people who benefit from social interaction paired with healthy lifestyle education and exercise. These programs also relieve the fears of people with certain diseases about exercise (in other words, people with heart and lung disease learn that exercise is safe for them.) 
  • People undergoing chemotherapy would not be surprised to find that hair loss is the least of the side effects they will experience. Disabling fatigue is the most common and troublesome cancer symptom, but people do not know this before they start chemo. Other side effects are infertility, depression and instant menopause for even young women. Everyone, in my fantasy health care system, would understand the benefits and risks of their own treatment regimen before one molecule of chemo enters their body. This would mean skilled educators explaining, demonstrating and showing patients what to expect as many times as it takes, for as long as it takes, using many different methods. 
  • Ditto for surgery. Relying on surgeons to do the explanation of risks and side effects is the fox guarding the henhouse. 
  • Just as my mail-in pharmacy phones me to remind me when it's refill time, people would be reminded by phone and email when their children need vaccinations, when they need that regular screening physical or colonoscopy, when to visit the dentist, when to get an eye exam, and so forth. We are overcome by information and demands on our time - the health care system must help people put priority on health maintenance, or it is easily forgotten.
  • Vitamin deficiencies are entirely preventable. A once-daily multivitamin for every citizen should be covered by the health care system. Calcium for women, too.  Both of these are cheap. 
  • Not-for-profit public exercise clubs with group classes would be available to every citizen for a small fee per visit. For personal trainers we would pay out-of-pocket. 
  • Every person could call a single toll-free number to get health coaching by a nurse or person with a degree in health education (i.e., the people who are educated to do this well). The program would not be linked to their employer in any way. Because I suspect assurances of confidentiality from employers who dole out discounts for taking part in insurance company-run health improvement programs do not convince everyone. The baccalaureate-prepared registered nurses and healht educators who answer the lines would perform a focused health interview and use evidence-based strategies to help people live healthier lifestyles. No guilt; no shame; no overwhelming demands to fix everything at once. No idiotic "You should lose weight" to someone who has struggled their entire life with obesity. (I kid you not -  I hear this all the time from physicians; they do not know how to do health coaching, world.)  
So that's my short list. Add your own health care plan improvements in the comments. And thanks. 

* Industry may not be the most apt noun because most of our health care costs are paid in public systems, primarily Medicare and Medicaid. I prefer industry vs. system because there really is no system; we have more of a mish-mash of systems.

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