Relationships answer to health care problems
Whether patient or practitioner, few dispute that U.S. medical care is reaching its critical mass, in delivery, efficiencies, and costs. One local M.D. has given the matter a lot of thought, and shared in brief form his conclusion. Simply put, both problem and solution lie with society, not politicians.
Why? Because it’s about human integrity. Health care’s focus has transitioned from patient to disease itself. We need to reverse that paradigm shift.
“You cannot disconnect the science of medicine from the person’s inner spirit,” writes retired physician Bill Tarnasky, stressing with multiple examples the mutual relationship between mind and body, and modern approaches which emphasize that connection less than they once did. He believes today’s physicians and their patients less often distinguish problems arising from life issues or choices (thus treating their physical effects, without addressing roots), from those with organic causes.
Dr. Tarnasky has broader experience than the average physician. In addition to qualifications as both a doctor and lawyer, he was chief of staff for Kootenai Medical Center and represented an Idaho professional medical association on Capitol Hill. Sharing first-hand observations and studies, he illustrates how medical care has changed radically for both patient and doctor, to their mutual frustration.
One citation stands out: Studies show 20 to 30 percent of U.S. health services have no benefit at all. Think about that in terms of wasted time, pain, and cost.
Describing the problem simply in his brief treatise, “Integrity Matters,” Tarnasky said the solution to the medical care dilemma — what will restore its vital, unraveling integrity — must begin with providers and, impliedly, medical schools.
Among his key points:
Five life practices affect health the most:
(1) A good diet, with a focus on food sources over supplements; (2) exercise, as simple as choosing stairs over elevators, and regular walks; (3) not smoking; (4) attitude — “the thoughts we have determine how we feel;” and (5) personal relationships, which can manifest physically when out of balance.
Doctors are less connected with patients. This is the book’s running theme. Stressing the erosions of: a person-to-person connection, adequate evaluative attention, compassion, and broader and more personal questions asked, he illustrates how better conversations result in more effective, and often cheaper, treatment. But it’s quicker to just diagnose and write a scrip, with a full waiting room of patients who tend to expect exactly that.
EMRs and practice overload make it hard to change. Considered the greatest advancement in the health care system, the helpfulness of now-required electronic medical records (EMR) also has a major disadvantage. Meaningful notes and eye contact are replaced by time-consuming key-punches and printouts. Tarnasky believes this focus on EMR emphasizes the perception of sufficiency over actual care. The uncertainty of insurance reimbursement, coupled with high expenses (e.g., technological, legal, and administrative) also shift energies away from patient care.
M.D. training’s (unnecessary?) hypercomplexity and expense are leading to shortage. Most physicians were initially attracted by the desire to help others; however economic and other considerations have overtaken that. Diseases, treatment options, techniques, and technologies have all proliferated, creating a paradox of additional school years and “training overload” which make potential doctors think twice about the time, trade-off, and expense.
Med students are taught to use all diagnostic and therapeutic sources available (and there are so many now), so intervention is valued more than care. Tarnasky asks if with modern technology, need so much more be absorbed before practicing medicine? Might practical observation under experienced physicians replace some of this?
The famous cardiac surgeon Michael DeBakey said excellence in medicine is not confined to technique, but means understanding the concerns, apprehensions, and feelings of helplessness induced by illness. He emphasized that compassionate listening, and — rarely given thought today — a gentle touch of the hand “has a remarkably salutary effect on patients.”
Probably on their doctors, too.
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Sholeh Patrick, J.D. is a columnist for the Hagadone News Network. Contact her at Sholeh@cdapress.com.