politics and practice based on mindfulness

Monday, April 13, 2009

Obama & healthcare (part II): how to achieve "universal care"

As primary care doctors, what we can do to improve the health of our aging population is to take time to listen to all of the numerous symptoms reported, review medications, then decide upon necessary care and coordinate specialty care, if needed. 

This cognitive work is crucial to avoid unnecessary and costly procedures that may also be dangerous to a patient; yet, there little reimbursement for this essential aspect of care. Our system is geared toward more profitable, high-tech interventions and tests. 

Many family doctors are forced to see a patient every 5-10 minutes to support their increasing overhead.  The failure to provide quality care ends up costing the system more, because without adequate time to manage a patient’s problems, doctors send more patients to specialists where the care is more expensive.  Over 20% of Medicare patients have 5 or more chronic illnesses that require this comprehensive primary care management.

It takes only 3-5 minutes to write an unnecessary antibiotic for a cold and 15 minutes to explain why Penicillin is not effective for a cold and what other supportive medicines, herbs and vitamins may ease the symptoms. 

In the larger view, we as a country have become almost exclusively reliant on technology, prescription medications, and invasive procedures for our health.   A new vision of self-healing is needed.  

I have witnessed this new standard of care first-hand at the University of Arizona in  Dr. Andrew Weil’s Integrative Health program.  Dr. Weil trains physicians for the new paradigm, although in some ways, it represents a return to an earlier time.   His mission is to educate practicing physicians and medical residents about mind-body healing, spiritual aspects of healing, botanical remedies, exercise, and in-depth nutrition science. 

“Imagine a world in which medicine was oriented toward healing rather than disease" says Dr. Weil, "where doctors believed in the natural healing capacity of human beings and emphasized prevention above treatment. In such a world, doctors and patients would be partners working toward the same ends."

As we move away from a system that supports unnecessary interventions with little to recommend them in term of studies or evidence, we'll need to offer patients more in the way of health promotion.  So to achieve "universal care", medical school and residencies will train MDs to offer health promotion, integrative wellness, and nutrition classes, and not solely focus on disease-oriented approaches.

--submitted by Dr Deborah Campbell MD

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