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Healthcare Reform > How to save our patients and ourselves

This is the final installment in a four-part series first published here on FreelanceMD.com that started with an exhortation for all health care providers to “Raise Our Eyes.” Nurses and doctors act like bloodhounds tracking a scent. We are have our noses to the ground and our eyes fixated on what is directly in front of us, with no idea about the wider world out there.

Part II reviewed why our eyes stay downcast. It concluded that while our reasons may be valid, they do not excuse our neglect of the Patient called Healthcare.

Given the innumerable times I have been asked this question, I had to answer it in Part III: “How did our calling turn in to a job?” You will definitely want to read this.

I suspect you are just like me. If somebody complains about a problem, they need to suggest a solution. I give no credence to someone attacks our country without saying what a better system would look like and who has it.

So, what is my solution? What is the proper treatment for Patient Healthcare? The answer is straightforward. What would you do to cure any sick patient?

You evaluate all the (A) evidence – history, physical, lab tests, relevant literature, including what has worked in the past – to uncover the etiology (B) or root cause(s) of the patient’s ailment. Then you create a therapeutic partnership (C) with the patient and together, you (D) treat the causes of illness, not just the signs and symptoms.

As an aside, ask yourself how many of the four-steps-to-cure (A) through (D) the current doctor for the Patient, called Congress, has employed over the past fifty years.

The book “Uproot U.S. Healthcare” clearly delineates those root causes for critical illness in Patient Healthcare, such as the ten reasons for spending money in healthcare, eight of which we can and should eliminate.

Armed with the root causes (Steps A and B done), you would naturally proceed to step (C). Since the key problem is that healthcare lacks both principles and system-ness, you treat its deficiencies: give it principles and system-ness.

We are Americans. We do not take kindly to orders from above. Indeed, our country was founded on the principle of individual freedom from governmental tyranny. So, if Patient Healthcare needs principles, we will not accept them handed (down) to us. We will have to create our own consensus of principles, just as the Founding Fathers did with the Declaration of Independence and the Bill of Rights.

The technology is readily available to have an extended ground level whole-nation dialogue about issues in healthcare, ultimately leading to a plebiscite that will define the principles to guide a new system. If we try to treat without going through this process, the Patient will continue to deteriorate.

The second deficiency that plagues Patient Healthcare is that it is a “system” in name only. It is completely disjointed; has perverse incentives, such as paying for sickness but not health; treats providers like ‘perps’ (guilty until proven innocent); offering profit to withhold health care; and tracking the outcomes we don’t want but not the ones we do want. As Robert Moffitt of the Heritage Foundation testified before Congress, “You cannot get more of something by paying less for it.

THAT is the so-called “system” you and I have to work with and in. No wonder more and more providers are becoming disillusioned. Trying to reform this non-system is like trying to cure breast cancer or coronary heart disease with acupuncture. You cannot “adjust” a submarine so that it will fly. Patient Healthcare’s system cannot be “reformed.” In computer language, the motherboard was built by people who know nothing about programming or computers. Both the nonfunctional motherboard and the non-existent Healthcare “system” must be replaced.

Ignore the realists, the self-styled pragmatists, who say it cannot be done. Starting with 13 separate colonies, we created a principled nation that is now a world super-power. Putting a man on the moon was impossible and so was curing leukemia. But we did those things. We can cure Patient Healthcare.

Deane Waldman, MD MBA, author of “Uproot U.S. Healthcare,” your doctor's guide to curing Patient Healthcare. See: www.uproothealthcare.com.

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