03.19.09
The changing, everlasting, medical alliance
Imagine a flock of birds. Imagine them migrating a cross a clear blue sky.
The flock flies as a unit. They are led. But the leadership and the formation change. The direction in general is clear. At any one time it might not be so.
Our flock is called Medicine. The birds are the patients, the Doctors, the health providers and the pharmaceutical companies.
There is an ever-changing flux. But they same as one flock.
Their aims are but one. A healthy society with healthy individuals. Their secondary goals and limitations are different. But they have more binding them together as a flock than anything else.
But today’s flock is leaderless. There are tensions, a lessening of cohesion. The flock is not really getting to where it wants to go.
Let us look why? Maybe we can find a way to re-instate cohesion.
The patient understands health as an absence of overt illness. When he is not ill he is well. The Doctor understands things a little differently. A person may not be overtly ill and yet not healthy. The pharmaceutical company understands that he has to back the Doctor but is suspected by both as having ulterior motives. So who is to lead? Who can regenerate cohesion?
We have to now discuss two new terms. The first is attrition and the second compliance. Attrition simply means that the patient stopped doing what the Doctor said. Compliance means that he does what the Doctor says but not as he was told. For example e takes his tablets but not every day. Not as often as he should.
Life would be so easy if there was a linear relationship between the words that leave the Doctor’s mouth and the tablets that enter the patients. But there is not.
Why is this so?
Let’s take a look at the Doctor. He hasn’t the the time to explain. He hasn’t the skills of presentation or indeed communication. He even sometimes does not have sufficient knowledge to answer questions. Now for our patient. He is more erudite or at least so he believes. He has to hand many facts. He has not the power to integrate them. If before he was ignorant then now he is confused. It is harder for him to get to his Doctor. He has to pass a myriad of barriers: Automatic answering services, cumbersome switchboards, services that he does not feel intimate with; changing Doctors schedules. For him the medicine has become mechanistic. There is an all pervading feeling of distance if not alienation from his Doctor. When he does get to see him his Doctor is hidden in part at least by a computer terminal screen. His eyes riveted either on the screen or on the key board. His Doctor is no longer the soothing parental figure of the past. He is a harassed bullied technocrat. The Doctor – Patient relationship is not dead. But it is certainly moribund.
As medicine has progressed so has it’s basic goals. In day’s gone by Doctors either prevented death or witnessed it. The patient either died or got well. Today they do nether. Today we are into the age of either preventing illnesses or preventing them from becoming worse.
Now we can see where the difference in expectations about health arise and why it is so important.
The patient has to both avoid attrition and comply to the Doctors instructions.
And this is where the flock is faltering.
The flock as a whole has to realise that there are six stages:
1. Understanding: A simple but efficient way of explaining to the patient what he can understand.
2. Knowing: The patient not only understands but accepts fully the explanation.
3. Applying: Doing as he should but not ‘automatically”.
4. Using: Doing as he should as part of an accepted routine
5. Stopping:The inevitable stage. It will always happen in any chronic treatment.
6. Restarting: Easy to do if there is someone to tell him
In short we need good explanations and good follow up. Ideally this should be the Doctor. Unfortunately we know that he is incapable. He has neither the time or training. The patient as we have stated has not the inclination. So we are left with the health providers and the pharmaceutical companies. Of the two it is the companies who have a true vested incentive to undertake the task. There is but one pitfall. There is a natural suspicion about motives. This suspicion is ill founded but certainly present . It is just as certainly circumvented. Unfortunately it is not enough to state, correctly and succinctly that although drug companies have a vested interest this in no ways diminishes from the need to supply information and follow up.
So what is needed?
1. A vehicle that promotes understanding and the acquisition of knowledge.
2. A vehicle that detects drop out. It detects the inevitable stage five and shorten stage six to a minimum.
This vehicle is the Internet.
In order to overcome the hesitancy about the pharmaceutical companies the vehicle should be sponsored by but be autonomous from the Companies.
I am suggesting adding a gosling to the flock.
A gosling sired the pharmaceutical companies.
A gosling that is autonomous.
The gosling will promote compliance and prevent attrition.
The patient and Doctor benefit by the improved health. The health authority benefits by increased efficiency and less recidivism. The companies by increased sales.
A gosling who can cause cohesions and increased well being to the whole flock.
In the fullness of time the gosling can grow. The goslings functionality can increase.
It can facilitate easier contact with the Doctor by anticipating when he should visit to say renew his prescription batch. At a later stage he can anticipate possible problems with possible solutions.
As an example a stressed 35 year old woman receiving anti-depressants can be screened for possible learning dysfunction in her children or maybe an otherwise non-discussed male sexual dysfunction. Suggestions can be made. Appointments may be made.
As the system beds down confidence in it will grow. The Doctor, seeing his patient attaining the results he so desired will openly and gladly cooperate with it.
The flock is short of one member. The gosling as a case worker. As in all case working the case load should deepen and become intricate and complex.
But in every situation the flock as a whole benefits. As in all flocks the increased well being of the flock is represented by the increased well being of each and every individual member of the flock.
Can we migrate to this system?
