Posts Tagged ‘Medicine



01
Mar
10

Health paradigm shift needed for the 21st C, part 1

The Society for Participatory Medicine recently asked its members (I’m one; it’s open to the public) what they wanted from the society. The request prodded me to think about what might be undertaken to advance “participatory medicine” or “health 2.0” which are similar if not identical concepts. Others might be better at identifying distinctions.

The purpose of the Society for Participatory Medicine is: “To accelerate change in the culture of healthcare to a more participatory model, through leadership, advocacy, information and tools.” I think it’s fair to say “participation” means a more even role between doctors and patients in making decisions in medical situations. If you go back to my parent’s generation (mid-twentieth century) typically doctors held the information, authority, and decision making power in virtually all medical situations. People didn’t expect to need to know much because, if you got sick, you went to the doctor and he — typically, he — told you what was wrong, what he’d do about it, wrote the prescriptions, and sent you to the hospital if necessary. If you lived in that era you know that generation gratefully accepted the doctor’s direction and didn’t ask many questions. The TV show Marcus Welby, MD, dramatized the medicine of the time.

But, as I described in an earlier post, a portion of the population was not satisfied with the situation and began to question established practices. This was especially true of women not too happy with male-dominated gynecology. In the 1970s, as I recall, emphasis on “informed consent” began to grow. When I went to work in cancer public health in the early ’70s it was shocking to learn that some doctors did not tell some of their patients they had cancer because the physicians judged the patient couldn’t take the shock. The patient participation movement has really accelerated since the internet broke the dam on medical information. The public has gotten much freer access to information from sources other than their personal physicians, which, in may cases, wasn’t much.

That’s the past, the 20th century model. Where can we go from here? Organizations are pushing the envelope, but I’d like to entertain a few ideas for the 21st century that would shift health and medicine in a more radical way.

In earlier times much of health care was the domain of women: an extension of their maternal, nurturing role in the family. The late 19th and the 20th centuries saw the rise of “scientific” medicine. (For an excellent history get hold of sociologist Paul Starr’s, The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry. The title alone says a lot.)  The complexity and volume of medical knowledge as well as the financial advantage of professional exclusivity eventually resulted in the consolidation of medicine into the system of medical education, licensing, legal authority for therapeutic practices, and self-policing that dominates today. And the swelling of a huge medical industry focused almost exclusively of physicians as the kingpins and market managers reinforced the doctor-centered system. The responsibility for learning and applying medical knowledge placed doctors in a paternalistic position while patients remained in a passive, unschooled position.

I would not challenge the notion that medicine has made great progress under the current system, nor that the trend to super-specialization of medical knowledge will continue. But I have to ask: Should relative passivity and health ignorance of the public and inability to make health judgments remain our aspiration going forward? Are we not capable of knowing much more, of participating more fully in  effective health behavior? That includes accepting the power and responsibility for our own wellbeing. In the past when information was more difficult to distribute relatively low health literacy might have been more understandable and acceptable, but surely we can do better in the future.

My position is that we have already more powerful knowledge tools than even a couple of decades ago and those tools are growing in capability as we speak. There are seeds of a potential to put individuals in a much improved position if we are willing to build systemic support and institutions that augment our abilities as much as the institutional infrastructure that supports the medical profession. It is possible if we have the will to put much greater innovation into it. I believe we can up our game as “patients” — the noun we have accepted — and relate to physicians and scientific/medical institutions in a more capable way.

This is not just some power grab. It seems to me taking charge of our health is not only possible, it is essential. The pathetic political struggle currently going on around “health reform” in the US shows how powerless we’ve allowed ourselves to become. While various interests use politicians as sock-puppets to stage a drama about the future of medicine, we citizens have become primarily ineffective, frustrated spectators. But I hope many folks have learned that we cannot continue to let our most precious possessions — our health and that of our family — remain in the hands of others. And we’ve learned our financial wellbeing is intimately tied to our health status. Serious disease has too often become a financial catastrophe aw well.

Well, I’ve spent a lot of words on the history and context behind what I think we ought to consider for a health promoting environment for the future. In the next post I’ll get down to grinding out the main points.

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29
Jan
10

My self-tracking: the prequel

I mentioned a few weeks ago that I’m doing my thing with adopting a permanent exercise and diet regimen. (Who isn’t?) This program has evolved. Starting back in July 2009 I wanted to get on a self-improvement track. At the same time I was getting interested in what I think is a very significant trend: health 2.0, participatory medicine, e-medicine or whatever else people are calling it.

I started by setting up accounts in both Google Health and HealthVault. Neither is very suitable for what I wanted to do: keep track of my exercise and diet. Both are designed to enable people to set up computer accessible versions of the records their doctor or health provider has. Fortunately I’ve been in good health most of my life, and I don’t have any complicated records of disease episodes or conditions to put in there — even if I wanted to. I say “if I wanted to” because it became apparent that getting records into these PHR (personal health record) systems either requires hooking-up with a limited number of providers, using go-betweens, or just getting your paper records and manually transferring everything in. It didn’t seem worth it in my case.

However, I discovered that HealthVault offers the option of linking your medical records account up to the MSN Health & Fitness site. Health & Fitness is specifically for recording exercise and food consumption. The data and graphs are then accessible in HealthVault.

Good idea, I thought, so I started recording what I was doing in the fitness form. The Health & Fitness recording system calls for you to make a daily exercise and diet plan. Then you keep track of what you actually eat and do for exercise that day and enter it at day’s end. The program then compares your goals with what you really did. That was a problem for me because I never know what I’m going to eat, and I wasn’t embarking on such a controlled diet routine that I was going to control it by, say, preparing and packing my lunch to the office. So, for me, the food consumption planning was useless.

Also, the interface for diet planning and recording is poor. You can search for a food or drink and select from alphabetical drop-down menus. But no matter how many times you have the same thing there’s no way to get a shortcut to your commonly consumed items. Finally, the exercise planning and recording is set up around running or gym workouts. All I wanted to focus on was walking. Believe me, I’m way beyond the six-pack-abs stage.

After about three or four days I realized this wasn’t going to be something I wanted to do for weeks much less years. There was way too much “paperwork” involved through an interface that wasn’t very helpful. Indeed, I ran smack into what I think is a very common obstacle for getting people engaged with health routines: doing the manual labor of keeping track of your progress. There are notorious hurdles in the way of people keeping up sustained health routines, and this is a big one.

I realized pretty quickly that I needed a better way of gathering my data. Coincidentally my cell phone contract was up for renewal, and I latched on to what I hoped (or rationalized) would be a big step forward in convenience of recordkeeping: the iPhone. That was the next phase on my self-tracking saga, and I’ll go into using a smartphone in more detail in the next installment.

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