Healthcare is an unprincipled non-system

Everyone knows (except Washington) that you cannot cure a sick anything – patient or system – without a correct diagnosis. What is the diagnosis for sick, “broken” U.S. healthcare?

Washington apparently thinks that there is not enough money in the system because the Bill they are discussing will add $1 trillion to our national deficit. That means they will have to print even more money.

Washington has also found greedy groups to blame: doctors, insurance executives, drug companies, even the patients, but never the lawyers and never, ever themselves. Might I remind Congress that the largest cost item for U.S. healthcare is the “waste of the middle.”

Both diagnoses – insufficient dollars and greedy group – are wrong. The reason why healthcare is sick is the title of this blogpost. Healthcare claims to be a system but is not. Healthcare has no guiding principles.

Every country with universal health care has two things that the U.S. healthcare does not: System and Principles. Each has a planned-in-advance organized structured process with rules, accepted outcome metrics, and a national medical information technology.

“Jumbo shrimp” and “I’m from the government and I’m here to help” are two widely accepted oxymorons: internally contradictory phrases. “U.S. healthcare system” should be added to the list. In place of a system, we have a bunch of warring tribes all speaking different languages with cultures in conflict and divergent priorities. If you like historical analogies, think Balkan states, Renaissance Italian principalities, or Greek city-states.

Our country has been through a number of tests over 233 years that could have torn us apart. The reason we survived and thrived is our single greatest strength: a clear declaration of principles, one with which we all concur. When we need to ask what to do, we can refer to the documents illustrated above.

What are healthcare’s guiding principles? When contentious issues arise, where can healthcare look for advice? Those were rhetorical questions. U.S. healthcare has no generally accepted principles.

Without its own ‘Bill of Rights and Responsibilities,’ healthcare is rudder-less. It cannot make a decision based on commonly accepted ideals because there are none. Healthcare simply responds to the loudest voice and is forced to react to one crisis after another because it has no game plan, strategy, mission or vision.

To have sustainable, affordable high quality healthcare, we need to agree on principles and create a coherent system based on them.

System MD

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#1 Why is personal responsibility so prominent in education and not even mentioned in healthcare? — Medical Malprocess on 09.28.09 at 3:12 am

[...] Health care is not a right. Health care cannot be a right for four reasons. (Health care – two words – is an activity. Healthcare – one word – is a system, well actually a non-system.) [...]

#2 zjin on 09.28.09 at 8:22 am

The free market is the system that presently guides health care distribution and administration in the U.S., and look at the mess it has created. That is the conclusion I get from your rant. So if the free market can not create a viable solution for health care, and given that health outcomes are as good or better for about half the cost in countries with universal health care, the solution seems obvious: universal health care.

Washington only regurgitates other peoples’ research and conclusions. Your notion that it “blames” is misguided since it is third-party research which does the blaming. Think tanks and other demographic research groups, like the McKinsey Institute, have looked at costs from all angles, and compared them to similar costs world-wide and adjusted them for currency and other demographic issues, such as subsidized medical training. The problem is profiteering in all segments of the health care marketplace. Is it greed or simply an artifact of a free market handling of a critical but scarce resource? Does it matter? The only important result is that it is a method that is failing.

Your conclusion, “To have a sustainable, affordable…” would seem to support a government funded solution a la other countries, – ironic since you seem to be so antagonistic to the notion in other statements.

#3 Nerdse on 11.01.09 at 2:25 pm

I can get on board with the idea of some coherent plan that guides things, but we do have something already. The oath you took, & the one I took, take as one guiding principle, “First, do no harm.” There is also a patient’s Bill of Rights & Responsibilities. It says the patient owns his or her medical record, & in exchange has the responsibility to provide caregivers with accurate & truthful information that will remain confidential & which will guide the plan of care. There is more along those lines in that document, so I believe the basics already exist.

There is really not so coherent a plan in socialized medicine as many seem to think. In my nursing career, I was privileged to work on an inpatient research unit. I learned a great deal, but not just about rare conditions like AMN (adrenomyeloneuropathy) & ALD (the severe version, called adrenoleukodystrophy), but also about how those in other countries viewed their socialized system against ours. To a person, each said they’d take ours, because our freedom from government intervention/regulation means we are the most innovative practitioners on earth. All of them cited the need to come to America to get cutting-edge care. I don’t think we need to be ashamed of that. We just need to close the loopholes in different places, & formalize what we already have.

Here are some things to consider, going to rights & responsibilities:

If I have a responsibility to get thin, then my physician has a responsibility to give me the tools. If those tools don’t work, my physician has neither the right nor the responsibility to call me a liar & a cheat, regardless of how many fat people in his/her past practice have ended up being liars & cheats. My physician DOES have a responsibility to te-evaluate the tools at hand & to engage in research, or send me to someone who has done so, to find tools that work.

The current tools for fat people (which I choose based on your blaming the demise of the nonsystem on fat people as the sole “largest” problem & the reason we’re threatened with socialized medicine) are simply reinventions of diet & exercise, in one form or another. Even weight loss surgery, which is an abomination but also a major money maker for doctors, is just diet & exercise revisited. Enforced malnutrition. Punish the fat person with a painful surgery that messes up already malfunctioning gastric hormones, some of which have probably not been discovered yet; bypass aseptic dressing technique to limit time with people you consider repulsive, giving them infections which you will blame on rolls of fat, not poor technique. If they have intractable vomiting, blame them for overstuffing the food pouch. Same for massive diarrhea. If they claim that months of infections, diarrhea, vomiting, & hospital trips have made them too weak to exercise, call them a liar & tell them to exercise instead of overstuffing the food pouch. After 5 years, don’t follow them; don’t track their premature aging & the massive health problems that come with it, because they cost more than it would have cost to stay fat & treat what they had.

THAT is NOT a solution. But when someone noticed a virus, instead of more research, they managed to make the person & the discovery disappear into the obscurity of derisive laughter – “A fat virus? Get real.” And we have yet to see any research into why some people eat 4000+ calories a day & don’t get fat. Sometimes you have to figure out why (besides “well, they probably have a fast metabolism” -duh…) a person stays thin when they’re gluttons to figure out why fat people can’t burn off what they eat.

The creation of new & better tools to aid in the treatment & cure of diseases means innovation, but currently, innovation in obesity research sucks. Gastric hormone research goes on only until they think they can find a new drug to throw out at diabetics, who are apparently all fat. The new drugs are made on limited information; they make patients sick (which, of course, they deserve since they’re fat), they do NOT result in weight loss, & they finally fade into obscurity while patients suffer & Big Pharma starts tossing out research dollars for the Next Great Thing. Or the resultant drug causes some sort of dangerous problem – like liver damage – that means they’ll hem & haw about taking it off the market, long enough for Big Pharma to make more money.

I guess it’s not a surprise. Cholesterol research essentially halted with the invention of statin drugs, which are dangerous because all the doctors chirp, like hypnotized parrots, “There is no such thing as an allergy to statins.” I beg to differ. I had a very severe reaction – & didn’t dare go to the local hospital; when Mom had the same problem, they parroted the company line & did everything BUT stop the statins & treat/document the ADR. I finally slipped her a ranitidine & a loratidine after I determined what they planned to give her – nothing. I might as well have kept her at home. That episode was a clear abdication of “First, do no harm,” followed by a refusal to treat the presenting problem based on what Big Pharma has told them about the drug, not on the first rule of allergies: People can be allergic to pretty much any substance.

The point of this is to say that doctors abdicate responsibility for patient care on a regular basis, & cite patient noncompliance as the reason why they no longer try. Actually, it’s their perception that patients are noncompliant because what’s usually occurred is the doctor has already labeled the patient a liar (especially true for fat patients). thus rationalizing their refusal to engage further.

No single physician can do all the research required to take a complex disease like obesity, but physicians can band together & put pressure on government for more research dollars – & for Pete’s sake, please don’t research yet another version of diet & exercise when that’s not working.

You all fulfill your rseponsibilities, & I’ll fulfill mine. just please remember there aren’t very many illnesses that work with just one cure treatment.

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