Prescription For America 2- Setting Priorities
Setting Priorities for the New Prescription for America will be no easy task. In this article, we'll look at suggestions for those priorities, including where money should immediately be diverted.
At all decision points in the process of reinventing medicine, it must be kept it mind that mental/emotional/spiritual aspects of healing are: 1) Free, and 2) Critical to healing. When a doctor first meets a patient his or her job is to:
1. Connect with that patient, realizing that his relationship with the patient is an important ingredient in healing.
2. Take a history, do a physical exam, order tests and determine the most likely possible diagnoses, a process which hopefully leads to finding the one main diagnosis.
3. Make treatment recommendations.
4. Inspire hope.
A doctor can inspire hope through reassuring words, and a hand on the shoulder. It is medical malpractice to tell a patient something like, “You have grade 4 metastatic breast cancer. You have 3 months to live.” Hope and belief inspire and activate our innate internal healing mechanisms. The removal of hope, through comments like the one above, demolishes people, and wreaks havoc with the immune system. Patients who believe these predictions are much more likely to “die on schedule” than those who are offered hope. Hope aids healing dramatically. There is no “false hope.”
Even when treating people with massive trauma from a car accident, who are not likely to survive, the doctor needs to maintain the same attitude. E.R. docs and nurses do everything under the sun to save the lives of people who arrive in critical condition. They may not be aware of it, but they “operate” from a state of hope, and only give up after 20 or 30 minutes of CPR has failed, the heart has stopped and there is a flat-line EKG (electrocardiogram). ER docs are wired for hope, even though they lose a number of patients every year. In the rush to save a healthcare system in crisis, the human element must never be lost. With that said, here are the priorities, as I see them.
Michael Moore's movie “Sicko” begins with an interview of a man who had part of two fingers cut off while working with machinery. He picked up the cut off pieces of his fingers and went to the hospital. His insurance company told the hospital they would pay for them to sew back on one of the two fingers. He chose to save his ring finger because what it meant in terms of his marriage. The last inch of his left middle finger was tossed in the trash.
All people requiring emergency surgery should have immediate access. All people who need to be admitted to the surgical intensive care unit (SICU) should have complete funding.
Likewise all medical emergencies, such as acute myocardial infarction (heart attack) and diabetic ketoacidosis should receive total financial coverage, without hesitation. These people need to be admitted to the medical intensive care units (MICU). People should be transferred out of the SICU and MICU only when deemed medically appropriate.
1. Fund All Surgical and Medical Emergencies
All true emergencies that can be managed in an ER should be funded. If you're in an accident and have trauma, or just break a leg, that might be fully treatable in the ER. One difficulty that ER's face is that many people without health insurance go to the ER for treatment of a cold or flu, a problem that a primary care physician in an outpatient setting can handle quite well. The average cost of an ER visit is $1,896. Somebody has to pay for that. Neither the hospital nor insurance company should be required to pay nearly $2,000 for every person with a cold who uses the ER as if it is their primary care physician.
ER's know quite well which patients are not truly emergency patients. In reinventing medicine, true emergency care must be available for all, but a system needs to be put in place that makes the individual responsible to pay the ER's bill if they are repeatedly using the ER as a primary care clinic.
Taking the pressure off of ER's, SICU's and MICU's depends on a solid, vast healthcare system that provides affordable primary care. It's no easy task, but the priorities are: a) if it's an emergency, we should all have access to treatment, b) if it is not close to being an emergency, ER's are not the correct place for treatment. Affordable access to primary care providers is the solution to ER abuse.
There are medical emergencies that can be handled on an outpatient basis. Some of these can be handled by non-MD's. For example, a great deal of physical trauma and resultant pain can be managed by chiropractors. Being flat on your back with excruciating pain is an emergency. It may not require hospitalization, but it's an emergency, and should be funded at nearly the same level as any other emergency.
One problem we face is that many people go to an ER with a symptom that they think might be an emergency, like a heart attack. It often turns out that the problem was not an emergency. It could have been heartburn and not a heart attack. We need to be reasonable in how these situations are dealt with. If the same person with heartburn (without other major symptoms like rectal bleeding) shows up at the ER over and over again, that becomes an abuse of the ER system.
2. Psychiatric Emergencies
Psychiatric emergencies are just as devastating and potentially lethal as medical and surgical emergencies. As with any emergency, psychiatric emergencies requiring hospitalization should be universally funded. Three major psychiatric disorders are schizophrenia, major depressive disorder and dysthymic disorder (a kind of depression). Depression strikes 20% of the US population at some time in their lives, and suicide linked to depression is the third largest cause of death among US teenagers. According to the National Institute of Mental Health the cost in adult loss of work time from depression is over $44 Billion. Because psychiatric diagnosis and treatment is complex and quite different (and less precise) than medical diagnosis, mental illness requires its own section in the Prescription for America.
3. Affordable Emergency Medication
Just as emergency hospitalization should be universally provided, so should access to affordable medication for emergencies. What is the point in hospitalizing a man with a heart attack, putting him in the MICU, treating him with IV meds, and round-the-clock nursing care, if you are not going to send him home with the medications he needs to stay alive?
The second line medication priorities are those medications that will prevent hospitalization and medical or surgical emergencies. This is not about “Preventative Medicine,” but these are the meds that keep the diabetic, the cardiac patient, the asthmatic, and the suicidal depressive – out of the ER and the hospital.
Real prevention is an entirely different issue and is where complementary and alternative medicine (CAM) has a serious role to play. Conventional medicine's greatest strength is in dealing with emergencies. Emergencies are our first priority, but treatment of chronic illness like arthritis, MS, and digestive disorders accounts for 75% of healthcare costs.
4. Pregnancy, Labor, and Delivery
Labor and delivery, and care of mother and newborn should be fully funded. However, we need to reevaluate the excessive number of C-sections done in America compared to other countries. Many C-sections are done because the OB/GYN won't get sued for a C-section. If s/he has the slightest inkling that there “might” be a problem with a vaginal delivery, s/he's going to opt for the legally safer procedure — the C-section. The OB/GYN is more likely to be sued for any problem arising during a routine vaginal delivery. This is a sue-happy country, which has led to the practice of “defensive medicine.“ However, if the delivery is in the hospital, the length of time in the hospital should be a medical decision and not a health-insurance-based decision.
The role of midwives needs consideration. Reports in the British Medical Journal of studies by Johnson and Davis's show:
a. Planned home births are associated with lower rates of medical interventions than planned hospital births.
b. For women with low risk pregnancies in North America, home births had similar risks of neonatal mortality as hospital births.
c. A study of 5418 women who gave birth at home with the assistance of midwives showed: substantially lower rates of epidurals, episiotomies, forceps deliveries, vacuum extractions, and caesarean sections than women with low risk pregnancies who gave birth in hospital.
Labor and delivery need top priority funding, but it is also a high priority to cut down on the number of c-sections, and consider moving toward pre-planned home-based deliveries with midwives. These changes will cut costs and decrease complications and death.
At every twist and turn in creating a New Prescription for Healthcare, we face feuding financial interests. OB/GYN's, as well as the AMA, are not likely to favor a move toward the increased use of midwives.
5. Universal Health Lab Card
President Obama and his health-team will need to be multi-tasking, figuring out the emergencies that must be funded NOW, but also looking at: 1) non-emergency problems that can be dealt with now, 2) prevention, 3) the role of Alternative Medicine, and 4) dealing with specific illnesses like cancer and AIDS.
We have the technology to put every lab test on a health card the size of a credit card. That card can include the results of physical exams, medications you take, allergies, x-rays, MRI's, etc. Nearly every medical office, hospital, and laboratory is organized and communicating with computers.
If you are in a car accident and arrive at the ER unconscious, treatment would be vastly easier if you were carrying a Health Card that could quickly be viewed on the ER computer screen. The doctor would know your diagnoses, medications, and allergies.
If you experienced some trauma, went to an ER and had x-rays, the x-ray report and the actual x-ray could be loaded onto your card. Then, if you decide to see a chiropractor or acupuncturist, and, you don't have the x-rays with you, your chiropractor can look at your x-rays by looking at your Universal Health Card.
The benefits are huge, so Congress, science, and medicine should get to work on this, so that it is implemented within 5 or 10 years. The only protection the individual needs is the knowledge that his card will not be used against him by his health insurance. It is essential that patient safeguards be part of this and that patient confidentiality be carefully considered in the development of the Health Card. This is medical information, not information for insurance companies.
6. Childhood Nutrition
Having spent decades practicing nutritional medicine, it has become clear to me that many of our children are not receiving one decent meal a day. Protein deficiency is not just a problem of the poor. It is a rampant problem, with an easy solution. We need “minimal nutrition” every day, meaning the minimum amount of healthy amino acids (protein), fat (essential fatty acids), and carbohydrates. We also need minimal amounts of vitamins and minerals.
It is extremely easy to formulate a tasty protein drink with a zone balance (40% carbs, 30% protein, 30% fat) that includes key vitamin and minerals. Suppose our schools provided this drink for lunch to every child in America! Amino acids are the building blocks of protein, body tissues, neurotransmitters, and hormones.
By having one protein drink a day, our kids will be physically stronger, and will get sick less often. Their brains will have enough of the key nutrients to make enough neurotransmitters, such as serotonin and norepinephrine (NE).
When our brains are deficient in NE, we have problems with memory, focus, and concentration.
One Protein Meal a day will improve memory and mental performance, and will cut down on depression, anxiety, stress, and attention deficit disorder (ADD and ADHD).
The Protein Meal can be handed to each student or can be part of the junk meal delivery systems already in place. We could have our kids press a button and their Meal would pour out like a smoothie. It is easy enough, and would cost less than $1.00 a day per child. The financial interests that compete with this idea are the junk food companies like Coca Cola, Pepsi, Pizza Hut, and McDonald's. They have dispensing machines in schools around the country, in exchange for which they contribute funds to the local school districts.
Another deal with the devil. School boards have fought the removal of junk food vendors, which contributes to the epidemic of childhood obesity and diabetes.
The immediate benefits of The Protein Meal will be evident within one week. Over the course of years, childhood illness will go down, chronic adult illness will go down, and academic performance will go up. The results will be fairly easy to study.
While this idea is not on the front-burner for those thinking of reinventing healthcare, it needs to be a number one priority, because with minimum effort, the wheels can be set in motion to make this a reality within a short period of time.
The easy part of this recommendation is development of the Protein Meal. It would take about 4 weeks to determine the necessary nutrients and ingredients of this Protein Smoothie Meal.
7. Remove Unproven Drugs
25% of the drugs in our pharmacopoeia have not been proven to work. This scientific conclusion has been reached at the highest levels of healthcare. It's time to remove all of these drugs. They are contributing to the multi-billion dollar pharmaceutical costs. In addition to the fact that these drugs don't work, we need to remember that the correct use of prescription drugs causes about 300,000 deaths per year. That does not include nonfatal reactions to medications. By deleting 25% of prescription drugs, we save money and save lives.
Healthcare must be reinvented. There are level one priorities, like medical and surgical emergencies that must be funded universally NOW. There are other level 1 priorities that are not emergencies, but are easy to implement and have long-term health and financial implications.
Future phases of the Prescription for America will include:
a. Mental Illness
b. Treating Mechanisms and Causes of Illness
c. Treatment of Chronic Illness
d. The Role of Alternative Medicine
e. The Impact of Stress on Health
f. Wellness Programs
David Gersten, M.D. practices Nutritional Medicine and Integrative Psychiatry out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access 1,000 on-line pages about holistic health at www.aminoacidpower.com.
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Is Your Past Interferring with Your
Is your past getting in the way of your future? Like most of us you've probably based your notions of the future on what has happened to you in the past. That's human nature. Your subconscious mind is designed to operate that way. That's how you learned 'to avoid 'hot stoves or' angry dogs even if you weren't aware that's what you were learning. However, if you want to transform your life now, you'll need to open up to a future free of the past. Fortunately, as an evolving human, you have tools for this. You have a potential for consciousness bigger than any sub or unconscious programming. You also have the will to move your awareness wherever you choose – as long as you practice!
Here's the tip.
First, begin observing thoughts to see how often you project past experience onto likely future outcomes. Second, spend 10—20 minutes (or more) per day sitting, bringing attention to your breath or body's experience by focusing on sensations. Choosing to bring awareness gently back to the present moment again and again increases consciousness and will. Next, notice how you feel about your future. If you discover sad, mad, scared or numb feelings allow brief emotional flow to bring you back to clarity and confidence. Finally, enjoy the spacious, empty, present moment that's always, paradoxically, pregnant with possibility. Be surprised. If you wish, choose a positive intention. The future is yours.
Penelope Young Andrade, LCSW www.penelopetalk.com Call: 858-481-5752 fax: 858- 484-8374 email: email@example.com
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