Comments

The next time my physician reccomends ANY type of elective procedure I'm going to just tell him I'm under the care of Doctor Peters who feels in this instance I should:

"Stay the f#^* away from the hospital"

Tom, you must really learn to be more emotive.

Posted by Greg at August 26, 2008 10:15 AM

Agree 100%. I have been to a doctor three times that I can remember in my adult life. Hospitals are for broken bones and life threatening injuries (cases where they are not likely to do more harm).

Their JOB is to find something wrong with you so they can fix it.

A doctor wanted to put my 80 year old mother on a blood pressure medicine that would be dangerous if she so much as missed a day. She told him no thank you, started meditating and and now has blood pressure lower than normal. And they also have decided her cholesterol is not a subject for discussion.

Posted by Ken Gregg at August 26, 2008 11:14 AM

Quote: "Their JOB is to find something wrong with you so they can fix it."

Reminds me of a boss I once had. He said:
"Don't call the Fire Brigade unless you can really see the fire. They have axes and hoses. They can't wait to use them ..."

Posted by Mike L. at August 26, 2008 7:05 PM

Tom, Thank you for discussing healthcare issues. There is too much money being made in treating problems versus prevention. "If it is not broke, don't fix it." More focus needs to be on alternative treatments as Ken mentioned. My mom had not been to the doctor in 15 years and she still walked to church at 85. She started talking in a strange manner so we were worried that she had a stroke. Took her to the hospital and they gave her all of these prescriptions and a month later she died of a heart attack. I was so nervous when my brother decided to take her to the hospital because I had no confidence in the system. Well, she might have still died but I feel that the hospital visit hastened it. It's a sad day that we do not have confidence in our healthcare system but they are making too much money on people being sick....So thanks again for looking at this issue

Posted by Angela at August 26, 2008 9:37 PM

Angela - So sorry about your mom. Blessings...

Posted by Judith Ellis at August 26, 2008 10:27 PM

Okay, strong on diagnosis so far - something's definitely not right with the patient. Rather weaker on remedies. So, what is the first step in a treatment programme?

Posted by Rob at August 27, 2008 8:38 AM

Any suggestions, Rob?

Posted by Judith Ellis at August 27, 2008 10:51 AM

http://www.forbes.com/2008/04/07/health-world-countries-forbeslife-cx_avd_0408health_slide_2.html?thisSpeed=15000

The link above is from Forbes.com using multifacet criteria - World's Healthiest Countries Top 15 - USA is No. 11 - Iceland, Sweden, Finland are 1-3 - France is 15th. Britain is not on the list. Stockholm here we come perhaps.

Posted by JT @ Google at August 27, 2008 12:53 PM

Hi JT - thanks for that information - I could not trace anywhere in the article itself or through a wider Google search whether in fact the UK was even one of the 138 countries in the survey. The article mentions that some countries could not be included as they did not tick all the boxes in effect.

The UK scores well in comparison in a World Health Organisation (WHO) report published today about the life expectancy of males. BBC News site. The UK also scores well on addressing health inequalities – particularly the social determinants of health.

http://news.bbc.co.uk/1/hi/health/7584056.stm

League tables are good but do not always tell the full story. A league table taken in isolation can be misleading

Posted by Trevor Gay at August 28, 2008 4:25 AM

My wife recently underwent a procedure in one of the "best" hospitals in Bangalore.

I told the physician that she is allergic to ibrufen.
I told the specialist.
I told the surgeon.
I told the Anesthesiologist.
I told the surgical assistants. I even told them to write it down on the sheet they were holding all the time.

Thank fully the procedure went okay, and on the day of discharge, we were given a prescription which we had to follow for the next week or so.

You guessed right. ibruphen.

Jay, from Bangalore
http://ideaburger.blogspot.com

Posted by Jayakumar Hariharan at August 28, 2008 7:20 AM

While statistics are valuable in determining distinctions and perhaps addressing problems, isn't it funny that we can find them for just about any cause we want to trumpet? I guess with health issues any statisctic used to better our health and bring preventative measures are indeed good. It's funny, though, how we often use statistics to determine who is the better and who is the lesser. But if we didn't have statistics how would we then determine that all important distinction of who's better?

Statistics allow us to sleep at night knowing all that's out there. This scope determines who's best of the civilized people fully drugged with prescriptions of every kind or natural remedies that can be just as toxic when taken in excess. We are an excessive people, aren't we? Moderation and Back to Eden may indeed be best--perhaps with a little help from counselors, friends, and pastors. How can we address the excessive problem? There must be a balance between stoicism and hedonism.

Anyway, sleep well, knowing that your country offers solutions to the rest of the world without actually knowing how the rest of the world lives. Perhaps there are no such dismal statistics as ours out there...wherever there is...

Posted by Judith Ellis at August 28, 2008 8:02 AM

Your post gave me pause, because I will going to our public hospital for a colonoscopy next week. I chose to go to public rather than private clinic to save money, and it is not as if the amount involved in not affordable even those without health insurance.

So I thought I would do some self management. I do have to prepare for the procedure. I thought I would also take the opportunity to phone the hospital and talk to one of the endoscopy nurses. It seems to me that you have to ready for anybody to be a nurse in the public system. I am impressed with their human skills and patience, and that gives me confidence.

Of course, there is a risk, but the procedure was recommended by my GP on the basis of tests and supported by my specialist.

There are problems in the hospital system in Australia, and as a patient you might have to be prepared to do it tough, but so far in my experience you get treated and get out quickly, a major bonus.

Posted by wmmbb at August 28, 2008 9:22 AM

wmmbb- All the best to you. Godspeed...

Posted by Judith Ellis at August 28, 2008 9:51 AM

Jay - Your story is truly amazing. What can we do? For starters, I guess we must be hyper vigilant on matter of our health; we musn't leave it to the doctors and nurses.

Posted by Judith Ellis at August 28, 2008 6:30 PM

To answer the resurgent Judith's question on my post, no, I don't have any particular suggestions (although you can read an earlier post of mine). Should I? My comment was simply an observation that it is relatively easy to accumulate examples (and as they involve human suffering, usually compelling examples) of disasters in healthcare and even to build those examples into patterns of What Is Wrong. What is not so easy, and what would be good to see more of, is thoughtful analysis of how an immensely (over-?)complex industry such as this could/should start Putting Things Right. One good doctor, one good hospital, one good district, do not make a good healthcare system, just pockets of good practice. So at the scale of a national healthcare system as a whole, is there one thread which can be pulled to disentangle the rest? Or, more likely I would think, are there various lines of change which have to work together for something better to emerge? If so, what are they, in whose hands are they or should they be put? So my comment was about shifting the nature of the dialogue towards the How, or possibly towards How The H***

Posted by Rob at August 30, 2008 5:29 AM

Rob your response is appreciated. The basis of the how was exactly my point--hence, my question of you or any others. It is, in fact, easy as you observed, to simply speak of the obvious without offering solutions, especially to complicated systems. I see that you have gotten the gist of question thoroughly.

Posted by Judith Ellis at August 30, 2008 1:38 PM

Tom,or Judith,

Here is an article from The New Zealand Herald that might be of interest to you. It seems to confirm some of the things you are saying. I wish I understood the health management issues you raise better, so I could make the case for them.

Reference:http://www.nzherald.co.nz/section/1/story.cfm?c_id=1&objectid=10530249

Posted by wmmbb at September 2, 2008 2:02 PM

wmmbb - Thanks for the article. I'll check it out.

Posted by Judith Ellis at September 2, 2008 3:05 PM

wmmbb - Thanks for the link to the article which I read with great interest today.

The overwhelming message yet again is ‘listen to the front liners’ – in this case the doctors - and you will not go far wrong in ANY business. This is particularly true in healthcare. And it is not rocket science.

Front line clinicians are in touch with patients (customers) all day, every day. They know the right answers. Managers and leaders most important job is making the job of front liners easier. I’ve always said that and I maintain that is the most worthwhile contribution any manager can make. Too many managers act as if their job is to try and make the front liners job as complicated as possible …… I don’t understand why they don’t understand this very simple stuff!

Posted by Trevor Gay at September 3, 2008 6:35 PM

wmmbb - In response to the article, it is not often that high turnovers are do to an environment that values its employees. By this I mean, it is very difficult to keep employees, no matter the field, if they do not feel valued. This includes making provisions for them with regards to needed equipment, training, empathy, vacation, awards, etc.

It seems like the "surgeon's confidence" seems to have had much to do with failed systems that have affected their work. This can be perceived as major slight by the surgeons. If the surgeons are not in a good place, you can believe that the patient will not be either. The instrument issue seems to have affected the numbers of patients at the hospital which, of course, affected "low patient throughput."

Morale may be another problem. Once low morale sets in an organization it is very difficult to deal with, no matter the profession. Hospitals and surgeons are not exempt. Even if the problems indicated in the article are dealt with, the focus of regaining morale would be essential for both the staff and the public. The sense of value, preparedness, and accomplishment affect performance and perceptions, internally and externally. Being given the opportunity to perform at one's best is important.

Regarding intervention, is prevention a better route? (I guess by the time intervention is necessary, prevention at that point has been neglected.) Every developed country seems to be focusing on the very important issue of prevention. What might help is what we eat on a day to day basis which would perhaps eliminate to a great degree heart bypasses and diabetes.

The fact that the government "was acting five years too late" is not surprising. Why is it that governments often respond too late, where private enterprise are usually quicker to respond?

By the way, wmmbb, I checked out your blog. I like it.

Posted by Judith Ellis at September 3, 2008 10:18 PM

Thanks Trevor and Judith for your comments and clear answers.

One thing that has been eating away at the back of the mind, is that my blood specialist, who has a ph.d in that field, brings out the file with an increasing number of individual reports, which admittedly show the last five or six results. When I ask, he tells me it is expensive to develop the software to create an ongoing report.

Thanks too, Judith for checking out my blog, and I am pleased you liked it.

Oh, by the way, I am the evidence that a public hospital procedure - gastroscopy and colonoscopy - can be survived. I saw the photos and the polyp they found. There was no rush to remove it.

Posted by wmmbb at September 4, 2008 8:28 AM

Best, wmmbb!

Posted by Judith Ellis at September 4, 2008 8:56 AM

Wmmbb – no problem about providing feedback – thank you for the link

Your experience of a ‘paper dominated’ healthcare system is sadly typical. Our National Health Service (NHS) is being dragged, screaming and kicking into a national electronic health care record for ever patient in Britain and the sooner we have that the better. It means massive investment by the government to make it happen but it will provide much more patient safety I am sure. I read somewhere about how many deaths and serious incidents occur in the healthcare system simply because of problems of illegible hand writing – this is crazy in 2008!

On the other hand it is brilliant to hear of the good treatment you received in your public hospital.

Most hospitals in the UK are in our National Health Service and therefore funded through taxation. Whilst we have problems with our healthcare system I am happy to say that the vast majority of patients experience a good service.

Of course some things go wrong and I never excuse mistakes that can be prevented. However as is well known on this Blog I am a strong advocate of a universal healthcare system funded through taxation until I see evidence of a better service for the ENTIRE population funded by the private sector and not just for those who can afford it.

Posted by Trevor Gay at September 4, 2008 4:32 PM

Trevor, while in principle I completely agree with your position on universal healthcare, I am interested in how you think it works for or against a culture of individual responsibility for personal health. The UK's NHS spends more and more (taxpayers', as you say) money on remedying the symptoms of gross personal neglect or indulgence, whether lack of exercise, smoking, bad diet, careless sex or alcohol-fuelled aggression and stupidity. Arguably (and this is put forward purely to prompt discussion) access to no-questions-asked universal healthcare diffuses any responsibility on the individual to think about the consequences of their actions. Would SOME requirement to contribute at least give pause for thought? In a sloppy analogy with 60's Britain, when the word "work-shy" was associated with unemployment benefit, do we now have a "health-shy" society in the UK? And is the availability of the NHS inadvertently contributing to it?

On paper records, I have little confidence in any move to an electronic system until the records are held by the patient rather than the medical system. Otherwise I confidently expect my records to end up left on a train, thrown away or erased by incompetent data managers, like other "confidential" electronic public data. A move to electronic data does not of itself cure sloppy process. I would make all paper records the property of the patient right now, with an immediate and hefty fine payable to the patient in the event the records are not available where they should be. That might get the attention of some paper-shufflers.

Pip pip

Posted by Rob at September 5, 2008 4:37 AM

Rob-I agree with the spirit of your comment. Personal responsibility has to play a major role in ALL that we do, from what we eat to how often we execrise to what we spend our money on. This shows our priorities. (Keeping up with the Joneses, even among the poor, is prevelant where image is more important than being responsible. This is not a general indictment of the poor. It is, however, an observation.) For me, the government is necessary where children, seniors, and the disabled are in need. There is no doubt that where the working poor is concerened, industry (corporations, pharmacueticals, etc.) can perhaps play a more concerned role--perhaps the government too.

Posted by Judith Ellis at September 5, 2008 8:44 AM

Thanks Rob – appreciate your feedback. I agree with you that a government provided universal system can potentially take away personal responsibility for our own health but actually I don’t believe that is the case in the UK. I really don’t think people smoke, become obese and don’t exercise simply because they know they will be treated free in a universal system if they become ill as a result.

There are many varied reasons why people do not look after their own health well enough. One reason is role model behaviours from parents and within families.

It is now a well researched fact that people who live in more affluent areas live longer and enjoy better health generally than people who live in deprived areas who live shorter lives and are generally less healthy. That will not surprise anyone of course.

Whilst it is indeed convenient and easy to blame the NHS for the ill-health of our UK population, that is not capturing all the reasons people do not look after their own health better. Because I have my car insured does not make me drive more dangerously. Because I have house contents insurance does not mean I leave my doors wide open every time I leave the house.

I understand the possible connection you are putting forward Rob I just don’t agree with it fully. I am not saying I am right by the way Rob – I hope I am never that arrogant. It’s just that I worry if we lose our universal healthcare system what will happen to the less well off and the frailer and seldom hard groups of the population without the guarantee of free treatment at the time of need regardless of wealth status.

Non-universal healthcare systems are fine for those who can afford it – I still believe one criterion any country should be judged by is what guarantees there are about healthcare for the most vulnerable in our society and I’m happy where the UK sits in that worldwide league table of nations.

I love your expression ‘a health-shy population’ in the UK and I am 100% with you on patient held records – that is definitely the way forward. A practical example from my healthcare career - I remember at least 15 years ago being involved in a project allowing parents to hold child records of health visitors instead of the traditional system of health visitors holding the notes. An audit 12 months down the road showed that LESS child health records were ‘lost’ by PARENTS in the 12 month period than the previous 12 months when HEALTH VISOTRS held the notes. Not necessarily conclusive evidence of course as it was a small sample but the principle of patients holding their own records with great conscientiousness was pretty obvious.

I can’t wait for the day when we all hold our own health records electronically – I just hope I live long enough to see it

Thanks for a great discussion Rob.

Posted by Trevor Gay at September 5, 2008 12:49 PM

Trevor-Education and lifestyle probably play just as great roles as wealth. The kind of education I am speaking of does not necessarily mean classroom education either. I remember going South for the first time when I was 13 and left with an impressionable vision: all of the seniors, some in their 90s, were strong, sharp, vibrant, and healthy.

These people were not wealthy by any means. They were very modest, moderate, and hardworking people who grew and prepared their own food, tilled their own land, and walked back and forth to the out house. For me, government funding in and of itself is not the answer. buy cheap viagra online australia

Are Brits more healthy than the people of other industralized countries... say Iceland? From what I understand the Iceland government plays a large role uniquely coupled with industry. Iceland, by the way, is my new favorite country since reading their stats from the link here and reading a little bit more about them, homogeneity aside. One really can appreciate a culture and a people without wishing to immigrate or dominate.

By the way, being right is not necessarily arrogant, but I guess neither is presenting a cogent argument necessarily right.

Posted by Judith Ellis at September 5, 2008 2:56 PM

Hi Judith – I agree with you. Most health improvements of the last 200 years in the UK have had little to do with doctors and nurses or healthcare providers – their job has been to fix people who are sick. Health improvement is more to do with improvements in sanitation, water supplies and other public health initiatives such as clean air projects.

Education outside the classroom is what I was trying to say when I talked of role model behaviour. There is no doubt in my life, my parents were my best role models about healthy lifestyle and that is way outside formal education systems.

I enjoyed your comment about older people. I love chatting to older people like my father-in-law who at 82 is sharp as a tack and full of experience. It is a pleasure to hear about his life – what he has learned and it is so educational.

I agree government funding is not the answer in itself but government has an important role. The government role could for instance be to encourage business to get employees to join health clubs by providing tax incentives for such initiatives.

I don’t know anything about Iceland though my brother-in-law has just returned from a long holiday in that country and he said it was a marvellous experience – maybe Annie and I will try it!

Posted by Trevor Gay at September 5, 2008 5:29 PM

Thanks for your words, Trevor. There are few Either/Or issues, education included; although, generalities and sweeping analogies really bug me. I'd like to visit Iceland some day too. I have traveled rather extensively but never there.

Posted by Judith Ellis at September 5, 2008 6:26 PM

Trevor, of course the whole picture contains many factors all bearing on how people look after their own health. But I think your car insurance argument actually weighs against your general point. You pay for your car insurance, and you know that if you make too many claims on it the premiums will shoot up; it is very much in your financial self-interest to be careful on the roads. Compare that with my current motoring bugbear, Post Office vans, driven by people who have no liability for any accident beyond a ticking-off at work, and so career about at reckless speeds to the danger of all. Sorry everyone, UK conversation here.

My point being that a direct interest in the result of any situation encourages responsibility towards it. There is not a sufficiently strong and widespread if-then case for personal responsibility for one's health in the UK. And that diffusion of responsibility also applies to the wider healthcare industry where, in spite of passionately committed people, the system acts directly against individual accountability for patient outcomes by dint of its scale and the localisation of tasks.

Posted by Rob at September 6, 2008 3:36 AM

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"My point being that a direct interest in the result of any situation encourages responsibility towards it."

Beautiful, Rob.

Posted by Judith Ellis at September 6, 2008 6:30 AM

Not my original, Judith. If you have looked at the work of social psychologists Darley and Lattane in the 1960s following the Kitty Genovese murder in NY, you will be aware of their concept of diffusion of responsibility. The essence is that the more people around a situation, the less any one person thinks it is up to them to address it. My opinion is that this is institutionalised in bureaucracies, a category into which most health systems fall. D & L created a five-point process to reverse the diffusion of responsibility, and this was later tested by another psychologist and found effective. So things can change. This change is the foundation of the work my project is doing with young people in Syria, hence my interest.

Posted by Rob at September 6, 2008 7:09 AM

Wow! Thanks, Rob. I'll have to check out the work of this psychologist. It looks like politicial parties know a little bit about the "concept of diffusion of responsibility." Embedded in the idea are decoys, mirages, and shift blaming, none of which address the crucial issue of how such problems should be addressed and what caused them in the first place.

Posted by Judith Ellis at September 6, 2008 8:37 AM

Hi Rob – I hadn’t noticed the ‘Post Office van syndrome’ but I will definitely now watch out for it!

Maybe you and I should put in a bid to manage the NHS between us – but I guess our question would be ‘What would we do for the rest of the week after Monday?’ :- )

Posted by Trevor Gay at September 6, 2008 3:08 PM

Trevor,
Workshops, overseas conferences, committees, outward-bound training, residential retreats for blue-skies thinking, you know the sort of thing. Can easily take up five days a week, and avoids the burden of real work altogether.

Posted by Rob at September 7, 2008 3:10 AM

Rob - You overlooked the fact we will both need a couple of PA's and a minimum of 3 deputies each ... so there will be plenty of time for us to play golf during the week where we can do our essential reflecting.

Posted by Trevor Gay at September 7, 2008 5:18 AM

Sounds good to me, so where do I apply?

Posted by Rob at September 7, 2008 6:36 AM

Judith, if you are interested it's worth Googling Kitty Genovese as the starting point for your journey. It's a harrowing story which throws a lot of light on human nature.

Posted by Rob at September 7, 2008 6:38 AM

Thanks, Rob. I'll do so for sure. My journey is endless, by the way. I don't remember its beginning and I will undoubtedly not remember its end. Thanks again.

Posted by Judith Ellis at September 7, 2008 10:14 AM

And...I love your proposed work schedule. I'm most definitely smiling.

Posted by Judith Ellis at September 7, 2008 10:18 AM