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?

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

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




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