Tuesday, September 9, 2014

Shifting Gears

As of August/September 2014, I have been a witness to the inadequacies in insurance based medicine.  The old adage of when you have a hammer everything looks like a nail is still true.  The talents in some of the doctors graduating from medical school is fantastic.  Unfortunately, there are also some very average healers out there.  The problem is if you have someone fighting for your life, it would improve the odds of survival if that person was as committed to maximizing health as you.  On a good day, in the morning, after a good meal and sleep....most doctors will probably be "on their game" in problems solving your predicament.  But as you know, most people "on call" for the ER probably slept poorly.  Most people trying to get through Monday morning traffic to arrive on time for office hours probably have been through 2-3 episodes of being cut off before arriving at destination.   Most people running late in the office are contemplating how to apply the "care algorithm" for your 2 biggest problems and delay addressing the others down the list until next visit.  Most people by the end of the office day have not eaten properly and are saving the most urgent calls for immediate call back and postponing other messages so they can "get the hell home" and let the office staff deal with the left overs.  Note that the higher you go with medical training (the sub-subspecialists) the less likelihood a response will be.

Speak of the devil, I just got a text from my wife.  She is in Florida caring for a relative who is being released from a chronic care facility as the insurance just ran out on the 20th day.  The nurse was teaching how to give an insulin shot to a newly diagnosed diabetic.  She was also teaching last minute (right before discharge) education on high glucose foods choices.  Some of the info was wrong....see this picture for the "average diabetic hospital meal"

....if this meals looks like it is sustainable to you then you are probably very thin, meditate and exercise daily.  This will be an eventual failed nutrition change that a patient will use to fall off the wagon and go back to eating starchy salty foods ....or go back to smoking, drinking and watching TV/with no exercise.   

Thinking outside the box is very important for designing lifestyle changes.  As well it is helpful for maximizing survival if in a hospital.  I watched as my father suffered a catastrophic medical event, and then was witness to sustaining his life for his last 2 weeks while in CCU, step down unit, surgery, ICU then hospice.   The hospitalist was outstanding and listened to my concerns.  The initial neurosurgeon was hard to speak to, and gave black and white answers quoting statistics (so giving the average answer.....treating my Dad as a nail).  The neurologist and 2nd neurosurgeon were excellent.  The pulmonary doctor who we didn't need (of all people!) was the most compassionate and helped with the ultimate decision of withdrawing all lifesaving measures.   Biggest problem I have is with the initial doctor who evaluated him while the event was happening.  12 hours prior to event, Dad was a 78 year old independent "grandfather" who was complaining of double vision.  If the doc may have investigated further, the brain bleed may have been halted sooner.   (...but what do I know, I'm just a primary care doctor who thinks anyone with double vision, headache and on coumadin should be considered for a CT scan stat).  This is the ultimate slap in the face that if someone is not invested in the care of every patient that s/he greets "hello"....then you are ultimately being treated as a nail by a healer with only a hammer.   

Having been educated by Andrew Weil, Deepak Chopra, Joseph Helms I have imbibed the idea that the current paradigm of insurance based medical care is not the only way to heal.  There are "energy based" whole systems of medicine that have been in place for 2000-3000 years.  Some people don't identify with the artsy-fartsy softer science of healing but one doesn't have to be trained in it....just have to acknowledge it exists- so if all else fails, entertaining another path may get the suffering expedited.   (suffering of the patient in pain/suffering of the family in sorrow/suffering of the community in loss of productivity/suffering of the nation in the burden of medical bills for procedures).  I love what my gurus have taught me about being more than just a hammer.  I believe it has helped my family stay safe.  Followers of my suggestions/videos can attest to a happier level of functioning.  They can also witness the disease that presents in others who don't follow my suggestions (got some 30-40 year olds that are the living embodiment of what happens when you don't exercise, don't eat mostly a plant based diet and don't learn to meditate/be in nature/practice yoga-pray for them!please!)  

Sometimes the only way to help people realize the changes they have to incorporate in their lives is the threaten.  Like any fight or flight response, threatening a heart attack or cancer will be effective only for a short time - until the f or fl response is extinguished.  It is then up to the patient to grasp the great feeling living with a springier step, faster injury resolve, better digestion, better sleep in order to keep lifestyle changes going.  More recently, one of the bigger ways for lifestyle change maintenance has been to have a little taste of the catastrophic event.  Perhaps this is where modern medicine is good.  With all the surgical techniques and expensive medicines available, we have been able to reverse some events temporarily.  So some people get to feel what a heart attack is like, what a round of chemo therapy does, what getting around with a handicap placard is like.  For them, maintaining lifestyle is inevitable or they go back to the same negative experience.  But what of the 500,000 people that will have their first heart attack the the last thing they feel?  This is where family can come in handy.  What ever the way, your average American will have a catastrophic event occur before 50year of age.  Shifting gears before the event happens is so crucial to improve survivability.  If the patient doesn't care-the family might; if the family doesn't care the community might; if the community doesn't care the nation should.  The burden of the sick is on the backs of the surviving.