Disregarding Humanity - The Great Health Care Debate Ignored

Writing is a way of exploration, a way to compare ideas and concepts. Some authors demonstrate the ability to break through and focus on the most important areas succinctly. Dr. Bailony demonstrates this ability and offers the opportunity to consider The Great Health Care Debate of Our Time Rarely Mentioned 



Will Health Care Continue to Embrace Humanity?



The greatest strengths and weaknesses in health care will always involve human to human interactions. In many ways our problems have multiplied because we have allowed humanity to be taken out of health care, replaced, minimized, and removed. 
Health care is grounded in human interactions and is most impaired by those promoting something else. Health care budgets were once solidly in favor of personnel - the people to interact with patients, families, and community. Each year more is sent elsewhere.

We have discovered more and more ways to interact, but we still are limited by minimization of the quality and quantity of the interactions.

It is easier to buy change or sell out to change.  It is much harder to invest in change that matters - somewhat costly, dedicated, interactive human beings, 
Deserts of Interaction and Deserting Human Interaction

As a society we clearly need more human interactions across the span before birth to death and beyond. We need to interact in more ways and in more places. 

We talk about deserts of food and deserts of health care, but not deserts of human interaction. Not surprisingly human interactions work perhaps most dramatically as seen in those with the least interactions - in interventions with the homebound elderly, in student interactions during home visits working with health providers to prevent readmissions, and in basics such as home postnatal visits to home elderly visits from community nurses common in many nations but not in the US.

One of the great experiences of my life was small town practice. Small town people due have fewer human interactions, but the interactions seemed to be to me to be greater in quality. It is possible to have so many interactions that the humanity is taken out of interactions. 

Health care interactions may well have multiplied, but the interactions most important have been minimized.
Where is the humanity...
  • In spreadsheet calculation regulations that shaved dollars during the Era of Cost Cutting 1980 to the present and beyond
  • In Diagnosis Related Group policies that cut off human interaction by fewer days of time for interaction, by fewer opportunities to interact with patients and families, and by too few nurses to interact with patients. 
  • In SGR and other payment designs that reward procedural technical care and compromise specialties maximizing human interaction in areas such as primary care, mental health, geriatrics, and basic services. 
  • In mail order pharmacies as compared to local pharmacists
  • In dial up/push button calls for mental health or other help without the benefit of a human interacting on the other end of the line (one size fits none)
  • In the care of veterans as most veterans are forced to travel too far for care because few can afford to live where veterans care is concentrated
  • In high deductible insurance where human interactions are minimized to catastrophic care - the type of care most desperate.
  • In Medicaid where payments are too low to support access to care or the team members that are human interaction
  • In blame and shame medical error studies
  • In across the board cuts that slash and burn without regard to human interactions
  • In just 22 - 24% of physicians and clinicians found in 2621 lowest physician concentration counties where 40% of Americans are found in places where over 43 - 48% of the humans most in need of human interaction.
Then there is the Tyranny of Research with lazy generalizations, misguided studies of central tendencies, more variations within subjects than between, and near total lack of inclusion of human interaction considerations. 
It is easy to do hundreds of thousands of regressions using convenience data. What is hard is actually capturing data on the behaviors, situations, human relationships, environments, and social determinants that actually shape health outcomes. 
Shouldn't we focus on human interactions rather than
  • Controversial yet irrelevant associations
  • Studies shaped by presumed clinical prowess
  • Male vs female internists (don't speculate or assume - assess interaction)
  • Urban vs rural location of care
  • US vs international origin internists
  • Quality measures
  • Race, ethnicity, gender
  • Certifications
  • Readmission penalties
  • Pay for performance/Value Based payments/MACRA
  • Medical error focus 
and other efforts devoid of human strengths, weaknesses, or interactions
Basic Health Access - Are Human Interactions Valued?

Why don't we understand that health care itself cannot exist without access, access that begins with human interactions?
Why not assure most Americans of human interactions through health care access instead of focusing on everything else for decades?

Recent Blogs 

Keeping Perspective Is Challenging Because of Turbulent Health Care Design

Disregarding Humanity - The Great Health Care Debate Ignored

Losing the Super Bowl Year After Year in Health Care

Focus on Finances Not International Graduates

Start with CHIP to Return to Sanity

Demographics Against the Democrats

Exploring Designs Favoring Blue Over Red

Scientists Fail at Science involving Physicians and Politics

Six Degrees of Discrimination By Health Care Payment Design

TeleOutreach or TeleProfiteering

The Tyranny of Health Care Research

Necessary Rather than Disruptive Transformations

Best of Basic Health Access Blogs

Does Academia Compromise Health Care for Most Americans?


Robert C. Bowman, M.D.        Robert.Bowman@DignityHealth.org

The blogs represent the opinion of the blogger alone.
Copyright 2017




Comments

Post a Comment

Popular posts from this blog

Another Fine CMS You Have Gotten Us Into

Perhaps we are indeed back to the time of Another Fine Mess (Laurel and Hardy). In a mad rush to implement innovation and to save all possible costs, CMS is creating complications for people that it is most responsible to protect. As PBS and Ken Burns celebrate the legacy of The Roosevelts, it is tragic to see what has become of over a century of effort involving Social Security, Medicare, Medicaid, and health care equity. The United States has one of the most complex health designs and clearly the various designers often know not what they are doing to others. More cartoons and comedians would find this a ripe area for material if not for the suffering involved. Health and Human Services has a huge role across Social Security and US health care. CMS or the Centers for Medicare and Medicaid Services has a dominant role to play in the design of health care in the United States.  CMS can be progressive or regressive. Interestingly CMS has chosen to appear to be progressive and in
Read more

The Essential True Reform Restores Primary Care and Much More

The list of distractions from True Reform are impressive. For decades True Reform has been specifically avoided as primary care worsens within practices and from outside. The demise is most specifically about the financial design. Unless there is a focus on True Reform, there is little hope for Basic Health Access. This may not make as much sense to those outside of family medicine. Family physicians not familiar with AAFP may also be clueless. If you think that you can fix primary care with more technology, more rearrangements, more types of health professional graduates, or more expansions of training - think again. None of these have any hope of working without financial design changes - major changes. The following are various concepts that dominate the discussions at AAFP and primary care meetings and media releases of associations and foundations and institutions. Members, staff, media releases, programs, and personnel have been reviewed.  There is little about Tru
Read more

Innovation Is the Problem Not the Solution for Worsening Health

Image
Innovation is good. Innovation worship is not good. Innovation application without scientific testing or clinical trials is unethical regarding clinical interventions and should be just as prohibited with regard to health policy. Clinical trials can harm hundreds or thousands. Innovative policies can harm millions. It takes a reasonable understanding of health care, health care outcomes, social determinants, and the investments that most improve social determinants to understand the consequences arising from the innovative nightmares past, present, and future. If you review the information sources with a critical eye, you too may find that the innovative policy designs have been disruptive to care, have hurt health care where health care is most needed, have reduced access to care, and have resulted in distortions in the literature. Indeed what is accepted and published in journals seriously lacks consideration of alternative hypothesis, lacks inclusion of many pages of limitatio
Read more