You deserve superb integrative health care

Is it possible that health care can become more effective, more personalized, more attuned to real health and wellness in a manner that truly benefits the patient as a customer/client?

The answer is “yes” but it will require understanding the dysfunction in the delivery system today, dealing with the growing shortage of primary care physicians and their non-sustainable business model, changing the insurance paradigm from prepaid medical care to (high deductible) true insurance for the catastrophic, and patients taking on greater responsibility for personal health and wellness.

There is excellent research and innovation along with superb providers is in this country. But the delivery system is dysfunctional and to date America has tolerated this dysfunction. It’s a medical care not a health care system. The emphasis is strongly on disease management and not disease prevention or health promotion. American medical care is very expensive, about $8,000 per capita, and yet outcomes are not what they could or should be. For example, America does not have the lowest infant mortality rate nor the longest life span. Other developed countries beat us on both counts. Medical care of acute illness is generally quite good in the United States but chronic diseases like diabetes, heart failure, chronic lung disease, etc. – of which there are more and more occurring – are not adequately cared for. The system is provider oriented rather than patient oriented and the patient is not the real customer of the physician or the insurer.

There is a shortage of primary care physicians and this is getting worse every year. Only 30% of American physicians are primary care physicians compared to about 70% in most other developed countries. Medical school graduates prefer to enter specialty practices. Those still in primary care practice often take less than adequate time for the prevention of chronic diseases. And too few appreciate or at least offer the time needed for chronic illness care coordination nor do they regularly integrate other options for care such as acupuncture, mind-body medicine, massage, etc.

Since today the patient is largely not the customer of the doctor, a good place to start is to change that paradigm. A high deductible health policy means that the patient will now be paying the primary care physician directly for care and thus this changes the professional-client relationship to a more normal occurrence. The physician will now become more attentive, allocate more time, offer more preventive care and will coordinate the care of chronic illnesses. True, the charge will be the same (unless the physician drops insurance entirely) which may not be any more adequate than before although the PCP should be able to save on the costs of billing and coding. When the PCP no longer accepts insurance and either charges fee for service or establishes a retainer based practice, the contractual relationship between doctor and patient is heightened.

Individuals also need to take more responsibility for their health and wellness directly. Attention to nutrition, exercise, stress and tobacco are key first steps. Work place wellness programs can materially assist. They can offer a health care premium reduction in return for engaging in added educational and action programs such as nutrition, fitness, smoking cessation and stress management to improve lifestyles.

Social networking can have an increasingly beneficial effect. Lifestyle changes are easier to accomplish in a peer group setting. Usually we think of this as a physical group setting but it can also be done through the use of social media. Groups help give a positive reinforcement for behavior change. Social networking through sites such as Facebook, Twitter or YouTube or others can be used to leverage the medical care delivery system to become more patient centered, more effective at the coordination of chronic illness, more attuned to prevention and responsive to true integrated medicine.

Everyone should have a primary care physician, one well schooled in the most current evidence-based care approaches yet who is attuned to the full gamut of integrative medical approaches such as chiropractic, nutrition, personal training, massage therapy, and acupuncture. You need to be sure that your primary care physician will spend the time needed to deal with health and wellness and not just disease. You may well need to pay your primary care physician directly rather than via insurance but the primary care physician will then be financially able to offer you the time you really need and deserve.

You deserve superb integrative health care but to get it you will need to take some action to obtain it. Call it a balancing of rights with responsibilities. It may cost you directly rather than via insurance but you may well find that the return on investment is well worth it.

You deserve superb integrative health careStephen C. Schimpff is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center and is chair of the advisory committee for Sanovas, Inc. and the author of The Future of Medicine – Megatrends in Healthcare and The Future of Health Care Delivery- Why It Must Change and How It Will Affect You from which this post is partially adapted. 

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  • NeuroMuscular Jct.

    I’d like to see more physicians be in tune with holistic wellness practitioners such as Neuromuscular Therapists like myself who can help people learn ways they can relieve their own pain through self-care, self-massage, stretching and other corrective exercises rather than always prescribing pharmaceutical poison that simply isn’t necessary. Remember Hippocrates? The father of modern medicine? I believe there is a quote “Let FOOD be thy medicine…”

    From what I have read, he also had a high regard for the art of massage and the use of friction on injuries. This is used by Neuromuscular Therapists.

    Thomas Edison’s quote is “The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease.”

    Although I am not a doctor, This is what my goal is and my intention. I educate my clients getting them familiar with the muscles and soft tissues of their bodies that they’ve never been introduced to by doctors or in school. This is what children need to learn in school, learn about who they are not just in the head… the body isn’t just a transporation unit for the brain… it is highly integrated with the body.

    Many patients just need guideance in taking better care of themselves, learning about what makes their body moves and functions!

  • davisliumd

    Agree that “health care can become more effective, more personalized, more attuned to real health and wellness in a manner that truly benefits the patient”.

    Not completely convinced that everyone wants to have the responsibility to do the integration themselves. Just two different schools of thought that exist not only in health care but also in technology.

    Do consumers what the responsibility and job to do all the integration? Android / Windows, etc. Do they rather have someone else do the integration? Apple.

    An example of the latter is where I work, at Kaiser Permanente in Northern California, a vertically integrated organization with health plan, hospitals, and doctors working together to provide care that is convenient, simple, and personal for our patients.

    Perhaps there is no illustration better of the potential of American health care than the words from a patient.

    Here’s why I chose Kaiser for my medical needs at age 25:
    1. I liked their Web site.
    2. It was easy to set up appointments over the phone and via the Internet.
    3. They have a 24-hour Advice Nurse phone line which is helpful if your parent is not “just a phone call away”.
    4. Through the Web site you can choose a primary care physician and OB/GYN by location, gender, and bio. If you don’t like your choice you can always change it later.
    5. You can email non-urgent messages to your doctor through the Web site and your doctor has to respond within 48-hours.
    6. The Kaiser Web site will send you an email when test results are available online.

    At age 29, here’s why I know Kaiser was the best decision I ever made:
    1. When I was brought to the Kaiser emergency room after my first seizure the staff was able to retrieve my complete medical history, which aids staff in making decisions about my care … even when I’m unconscious.
    2. After scans revealed I had a tumor in my brain, the head of neurology came down to see me and had me admitted to the hospital that night.
    3. My newly acquired neurologist arranged for my transport to the neurosurgery center for the Sacramento region.
    4. Once I got there I worked with Kaiser’s neurological equivalent to Dr. House, except this doctor was way nicer.
    5. My neurologist, neuro-surgeon, oncologist, neuro-oncologist, OB/GYN, primary care practitioner, orthopedic doctor, and physical therapist are all informed about my medical status.
    6. I never have to seek, or wait for, a referral. If a new specialist is needed for my care I get to see him/her as soon as I’m able to get a ride.
    7. I can get lab work done at any Kaiser facility and the test results are sent electronically to the requesting doctor within minutes/hours (or a few days if it’s analysis of brain tissue).
    8. Kaiser specialists network with peers from other medical institutions and often seek second and third opinions for you. They’ll even tell you who disagreed with them and why. If you want to get the second opinion yourself they are respectful of your decision and make sure you get all required materials to make this happen (e.g., charts, scans).
    9. After my most recent brain surgery, my tissue was analyzed by pathologists in Sacramento and Oakland, then sent to Kaiser in Redwood City, who sent it along to UCLA.
    10. While my friends and I did a lot of our own research, Kaiser made it easy for us to get treatment. We never had to figure it out all by ourselves and my doctors/nurse practitioners answered every question I had … even the silly questions.

    The future of American health care is unclear. Do Americans what Apple or Android for health care? Do they want the sole responsibility to integrate the care or would prefer doctors make it work?

    Davis Liu, MD
    Author of The Thrifty Patient – Vital Insider Tips to Staying Healthy and Saving Money (2012) & also Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America’s Healthcare System
    Twitter: @davisliumd

  • Margalit Gur-Arie

    How do poor and destitute children and elderly and disabled get massage therapy in this model? Or is this solution restricted to the affluent who already get better care than people in most other countries? (it’s those pesky unwashed masses that “ruin” the statistics…)

  • sFord48

    I am not sure how you come to the conclusion that given other countries spend less money and have better results with “socialist” medical care that high deductible insurance policies are the answer?

  • mbenioff

    Chiropractic? Acupuncture? Why are you promoting quackery?

  • Dr. Dan Spencer

    mbenioff – Your comment reflects part of the problem with our ‘healthcare’ system today. It is clear that you are ignorant of the significant body of research proving the efficacy and cost-effectiveness of chiropractic care. If only all doctors would work TOGETHER for the good of the patient instead of what their egos and/or pocketbooks desire!

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