In my pathology text, tucked away at the bottom of a paragraph in the chapter on cancer, is the following: “It begins to appear that almost everything one does to gain a livelihood or for pleasure is fattening, immoral, illegal, or, even worse, oncogenic.”
Oncogenic as in cancer-causing.
The statement is one of several refreshing, even whimsical comments in an otherwise sobering (and heavy) text, and it affirms that physicians are in part in the profession of saying no.
My own hang-ups about such an approach to health care aside, essentially, the way the current non-system works, that’s all they can do.
Fee-for-service payment has moved the system away from actual health care provision and toward increased volume of certain types of services – a 10-minute check-up, a quick assessment in the emergency department or a six-hour surgery. They are services that can be easily measured, coded and reimbursed.
Our payment system has caused patients to expect the types of interventions that have a discrete beginning and end.
The big problem with that?
The dysfunctional payment system has made it near impossible for physicians and nurses to address the stuff that happens before and after such interventions, stuff that really influence health, like lifestyle, because they’re too busy trying to keep their practices afloat by increasing the number of reimbursed services.
Work weeks aren’t getting any longer. Increasing the number of these services, quite simply, results in shoddy medicine, unhappy doctors and pissed off patients.
They can say, “Hey, don’t smoke,” or “Look, fatty foods are bad, try to eat more vegetables.” But they remain powerless when it comes to addressing broader approaches to daily living, which sit at the origin of things such as heart disease and excessive, voluntary exposure to carcinogens.
And what about us?
Even if we were to have health care system that directed its interventions at our lifestyles, it’s questionable how effective it could be compared to the decisions we make every day.
Too often, we do things because they feel good in the short term and they’re easier than the alternative.
Getting at certain decision points – when I decide to pull into Wendy’s at lunch time rather then get up five minutes early to throw together a sandwich, for example – is key to getting people to be healthier.
It’s difficult, to be sure, and the Obama administration, at least earlier this year, has talked of personal responsibility, of our role in reducing health care costs.
But distressingly, that essential piece of the reform puzzle has been absent recently.
Rehospitalization rate and medical error reduction, electronic health records, comparative effectiveness research and any of the other numerous cited proposed sources of cost reduction, while all important, are not as important as lifestyle intervention.
And lifestyle cannot be addressed until we first step up to the plate and become active about our own health.
Oncogenic as in cancer-causing.
The statement is one of several refreshing, even whimsical comments in an otherwise sobering (and heavy) text, and it affirms that physicians are in part in the profession of saying no.
My own hang-ups about such an approach to health care aside, essentially, the way the current non-system works, that’s all they can do.
Fee-for-service payment has moved the system away from actual health care provision and toward increased volume of certain types of services – a 10-minute check-up, a quick assessment in the emergency department or a six-hour surgery. They are services that can be easily measured, coded and reimbursed.
Our payment system has caused patients to expect the types of interventions that have a discrete beginning and end.
The big problem with that?
The dysfunctional payment system has made it near impossible for physicians and nurses to address the stuff that happens before and after such interventions, stuff that really influence health, like lifestyle, because they’re too busy trying to keep their practices afloat by increasing the number of reimbursed services.
Work weeks aren’t getting any longer. Increasing the number of these services, quite simply, results in shoddy medicine, unhappy doctors and pissed off patients.
They can say, “Hey, don’t smoke,” or “Look, fatty foods are bad, try to eat more vegetables.” But they remain powerless when it comes to addressing broader approaches to daily living, which sit at the origin of things such as heart disease and excessive, voluntary exposure to carcinogens.
And what about us?
Even if we were to have health care system that directed its interventions at our lifestyles, it’s questionable how effective it could be compared to the decisions we make every day.
Too often, we do things because they feel good in the short term and they’re easier than the alternative.
Getting at certain decision points – when I decide to pull into Wendy’s at lunch time rather then get up five minutes early to throw together a sandwich, for example – is key to getting people to be healthier.
It’s difficult, to be sure, and the Obama administration, at least earlier this year, has talked of personal responsibility, of our role in reducing health care costs.
But distressingly, that essential piece of the reform puzzle has been absent recently.
Rehospitalization rate and medical error reduction, electronic health records, comparative effectiveness research and any of the other numerous cited proposed sources of cost reduction, while all important, are not as important as lifestyle intervention.
And lifestyle cannot be addressed until we first step up to the plate and become active about our own health.
