A Softer Side of Health Care

By John D. Clague, Christian Science Committee on Publication for Oregon

Not long ago I had an email exchange with Dr. Pamela Wible, a physician in Eugene, about the recent documentary Escape Fire. The movie examines the problems with health care in the United States, and possible solutions.

Unhappy with the “conveyor belt” system of medicine that she had found herself in since medical school, “pushing pills into patients as they flew past me,” Dr. Wible got off the racetrack and stopped to consider what kind of health care system she wanted to work in.

The first step towards building her new medical practice was holding town hall meetings to see what patients wanted in a community health clinic. She describes her experience in building her practice around patient values for health in her recent book, Pet Goats and Pap Smears.

Because Escape Fire points out systemic issues that confronted Dr. Wible, I thought it would be instructive to discuss these with a physician in the trenches.

John: Several prominent physicians were interviewed in the film: Andrew Weil, Don Berwick, Dean Ornish, and Steven Nissen. They are pretty critical of our current health care system. Do you agree with their assessment?

Pamela: Yes. We have a disease billing system, not a health care system.

John: It was said in the movie that “conventional medicine suppresses symptoms which just keeps disease going. Do you agree with this view of conventional medicine?

Pamela: Yes, but conventional medicine is fabulous with trauma and tertiary care. We fail at chronic disease and certainly we lack the training to deal with the most prevalent health problem in America: Despair. Despair is at the root of self-destructive behaviors such as overeating, smoking, alcohol and drug abuse.

John: How do you measure health outcomes?

Pamela: By helping patients become self-actualized and fulfilled human beings. I don’t spend my time forcing them into algorithms that conflict with their values. I invite patients to define their own health goals. I align my care with their goals, not mine, and certainly not the system’s goals. We have an innate ability to heal ourselves.

John: It was also said that the interventions we depend on in our health care system depend on expensive technology (imaging etc.), and that includes pharmaceuticals. Do you agree with this?

Pamela: Yes. We have a high-tech, low-touch model. When I ask citizens in town halls to describe ideal health care, they describe the reverse. They prefer high-touch, low-tech care when possible. We breed dependency on a high-tech, complex system. The basic message to patients is that the answer to their problems is outside of themselves (in pills, doctors, machines). This is disempowering and dangerous. When I listen long enough, patients will reveal their real core issues. Unfortunately, we do not take the time to get to the root of their problems in ten-minute visits.

Dr. Pamela Wible
Photo used with permission

John: Seems to me that primary care physicians as the hub around which specialty care is provided would be the ideal model.

Pamela: YES!! YES!! YES!! We spend far too much time caring for the system, caring for profits, caring for insurance companies and third parties. Caring for patients and doctors is no longer the priority. 1) We need a simplified model. 2) We need ethical human beings at the helm. WITHOUT these elements, all models will fail. We need a spiritual awakening in health care. We are holistic human beings, not reductionist robots. Escape Fire, reveals the failure of our patriarchal, reductionist medical model. Though holistic therapies are suggested as the solution, the film primarily interviews male physicians and fails to showcase female physicians or innovative health care solutions developed by women in medicine.

The film was heavily focused on the “problems” we face in health care, yet did not offer a balanced perspective on solutions. We know the problems.

Dr. Wible makes quite a few important points about health care. I found her perspective on what female qualities can bring to health care interesting, especially since my own health care system was discovered by a woman, Mary Baker Eddy.

Even though Dr. Wible associates the qualities of nurturing, love, and compassion with women, I’m wondering if perhaps this is a way of highlighting these qualities. In her book she mentions men whom she respects, and who embrace a balance of male and female qualities.

It appears to me that problems in life arise when complementary elements such as male and female are divorced. Perhaps the whole nature of health care in this country could be readjusted and aligned by the recognition and reintegration of this balance. Caring, nurturing qualities are important to health care delivery, but not confined to one gender or the other.

In my reading of the Bible I’ve found it intriguing that the ‘great physician’, Christ Jesus, seemed to possess tough qualities, and yet expressed compassion and love in his healing ministry.

Pamela Wible is a doctor exploring these important issues and taking them seriously, introducing them into her practice with very positive results.

Does the health care system know best?

Americans are an independent lot. It’s rooted in the very fabric of this country. We are accustomed to having a choice and making our own decisions. That’s what we expect in our homegrown version of democracy.

We can choose virtually any product or service we want. Any size, shape, color, or model. Except when it comes to our health care.

It seems to me from much of what I’ve read that the patient-doctor relationship is mostly unbalanced. The doctor tells the patient what’s wrong, and what needs to happen to fix it. Our health care system forces doctors to quickly address the offending symptoms and move on.

In the United States more is spent per patient on health care than in any other developed country in the world.

For all the wonders of our nation, its unparalleled standard of living and freedom of choice, does this ensure that we are the healthiest country with the longest lifespan?

The United States came in at 37th place in the World Health Organization’s assessment of overall health outcomes of all nations in 2010. According to the CIA World Factbook, the U.S. currently ranks 50th for life expectancy. In 1950 we ranked 5th for women and 10th for men.

According to Gallup Polls, “Americans’ evaluations of healthcare coverage…show that much less than a majority of Americans are positive in their overall evaluations of coverage and cost of their healthcare.”

@ iStockphoto/Tom Hahn

Could it be that people are not satisfied because they don’t have much voice in their health care? Are their care expectations being met?

Shannon Brownlee makes the point in her book Overtreated. Why Too Much Medicine is Making Us Sicker and Poorer, that:

Strengthening the patient’s role in choosing a particular treatment or test is an important aspect of moving toward more efficient care. (pg.. 297)

A health care system allowing a more responsive patient-doctor relationship could provide for more effective two-way communication. The doctor could better understand the underlying causes of the patient’s symptoms and the patient could actually choose treatment options that fit better within his or her values.

Emerging aids to facilitate this process are decision tools that help patients make their own choices about health care. As Brownlee points out:

“…informing patients better, will very likely decrease overutilization rates:…clinical trials show that the use of decision aids leads to a decline in demand for surgery ——- about 25 percent overall.” (pg. 298)

Fewer tests and invasive procedures would lower costs and reduce the risk of adverse consequences.

This appears to be a central theme in shifting our health care delivery system. In her paper Emerging Patient-Driven Health Care Models Melanie Swan makes the observation that “The growing presence of patient-driven health care models may be central to the evolving health ecosystem. Individuals are starting to better manage their health.”

Within those models can be included all manner of alternative and integrative care. The whole patient needs to be attended to, including mental, emotional, physical, and spiritual needs.

In the late 1800s spiritual healer Mary Baker Eddy introduced a form of health care that puts the patient’s needs at the center of their care. She explains in her major work, Science and Health:

“Give sick people credit for sometimes knowing more than their doctors. Always support their trust in the power of Mind to sustain the body. Never tell the sick that they have more courage than strength. Tell them rather, that their strength is in proportion to their courage.” (pg. 417)

Patient-centered health care starts with our thoughts, whether they’re using a decision aid regarding the conventional health care paradigm, or addressing the connection between thinking and bodily health. Certainly better decision-making in a medical system is a good thing.

Is it reasonable to conclude that spending more time discovering the patient’s mental state and behaviors determined by their thoughts, and encouraging and strengthening the healthier thoughts, could be the basis for improved health?

Originally published on OregonLive

John Clague is a retired sheriff’s office captain, father of two grown sons, and husband. He now works with the media to ensure accurate representation of Christian Science.

Health Insurance–Everyone pays but is Everyone covered?

I heard someone recently talking about an acupuncture treatment that had helped him. He joked, “It may have been a jab well done, but I sure wish it was covered by my insurance!”

©iStockPhoto/courtneyk

All over the country, the question of health insurance is being pondered by governments, uninsured individuals, and employers, as they try to sort out what the new laws will require of them. And the insurance companies are looking at what coverage they can provide and at what cost.

The US spends more per patient on health care than any other developed country in the world. We now spend more than $2.5 trillion annually on medical care–a little less than 20% of the GDP. According to a Fox news report, in 1950, Americans spent about $70 billion in today’s dollars on health care. “After adjusting for inflation, we now spend as much on health care every ten days as we did in the entire year of 1950.”

Yet, In 2010, the World Health Organization assessed the overall health outcomes of each nation. The United States came in 37th.

And in a 2005 Johns Hopkins University analysis, “On most health indicators, the US relative performance declined since 1960; on none did it improve.”

In Oregon, as we move towards full implementation of our own health care reform and the federal Affordable Care Act, let’s not lose sight of our goal. Health insurance is certainly a means to the end, but it’s not the end itself.

Good health is the outcome people are looking for.

We need to be sure that all options for achieving and maintaining health are provided for in this reform, not just the use of conventional medicine. An expanded area of coverage that could be good business for everyone is some form of spiritual care. This kind of care can embrace many options, including complementary and integrative medicine.

While conventional health care costs are skyrocketing, many of these treatments are more modestly priced, less invasive, and with fewer side effects. And research shows that where responsibly used, they are safe and effective.

Americans are willing to spend $34 billion each year out of their own pocket on these alternative treatments, and in their experience there is good reason for this. They feel healthier than with conventional medicine alone. And some feel they get better overall care. Among the alternative treatments noted in the longest running survey on the trends in patient choice of alternative medical care, the number one top choice is prayer or spiritual care.

According to economist Robert Samuelson escalating health care costs will be especially hard on our children. “To aid the young, we could tighten Social Security, and Medicare, raising eligibility ages, and reducing payouts for wealthier retirees.” But, he says, this is politically unlikely.

Corporations and governments are rightly concerned about the proportion of income that now goes to cover health care, both for current and retired employees. Warren Buffet called General Motors “a health and benefits company with an auto company attached.” The price of every new car includes more than $1,500 for employee health care costs. And Starbucks spends more money on insurance for its employees than it spends on coffee.

Insurance companies operating in Oregon could take the first step of providing coverage for less costly treatments. At least one insurance company that tried this in another state found it to be good for its bottom line.

Right now insurance companies are making decisions on what will be included in their coverage at or above the “essential benefits” mandated by the federal government. If you have insurance and a special treatment option that could fall under the category of spiritual care, why not let your insurance company know of your interest in having it covered?

Or, you could hope to come across a doctor like comedian Joey Bishop’s, who said, “My doctor is wonderful. Once, when I couldn’t afford an operation, he touched up the x-rays.”

Previously published in the Oregonian

John Clague is a retired sheriff’s office captain, father of two grown sons, and husband.  He now works with the media to ensure accurate representation of Christian Science.

One path to health care, or another choice?

By John D. Clague, Christian Science Committee on Publication for Oregon

I’m curious about what’s missing in Oregon’s media on health and health care. You see plenty on health care reform, lots on the latest trends in conventional medical research, and much discussion about society’s hopes for a cure to our most obstinate health challenges. What you don’t see reported much is the public’s increasing pursuit of alternative and integrative health practices.

People are concerned about their health, evidenced by the fact that 80% of adult internet users are looking for information about health. And I believe that people are looking for solutions to their health concerns outside the mainstream system.

One emerging trend is the inclusion of alternative and integrative medical services by hospitals in their array of offerings because many of these practices are proving to be effective, they are less expensive than traditional care, and the public is using these services more and more.  In fact,  Americans pay $34 billion per year out of pocket for complementary and alternative medicine.

However, Michelle Andrews reports in Kaiser Health News:

“Although research supporting the efficacy of various complementary therapies is increasing, if hospitals confined themselves to those procedures supported by evidence there wouldn’t be much to offer,” says Ian Coulter, a senior health policy analyst at the Rand Corp. “(The same could be said of many conventional medical treatments, or course.) So hospitals pick and choose, based on what they judge to be most effective and what they believe patients want.”

According to a  survey by the American Hospital Association and the Samueli Institute, the most common treatments offered by hospital outpatient centers were massage therapy, acupuncture, and guided imagery (visualization and mental techniques designed to reduce stress). Pet therapy, massage, and music/art therapy are the most popular on an inpatient basis.

One practice not listed above, but practiced by 49% of those surveyed, is prayer. I practice prayer on a regular basis with good results.  I also value the practice of a healthy lifestyle.

I don’t pay a lot for my health care, and in fact I don’t have any negative side effects. What I do have is good health and I feel good, mentally and physically.

I’m wondering why Oregonians aren’t reading or hearing much about these trends in health care.  Sure, they aren’t the dominant resource for a healthy life in today’s complex society, but certainly they’re significant enough to warrant regular attention for the benefit of Oregon citizens.

Too much of the “right thing” could be the wrong thing.

It’s hard to imagine that administering routine medical tests would have negative consequences, especially when the test in and of itself is completely harmless. Checking to make sure there aren’t problems lurking in our bodies makes perfect sense.  At least until the consequences of doing so are carefully examined.

Here’s what’s happening:  a lowering of the threshold of indicators when tests are called for.  In fact, some tests are being administered at the onset of some general risk factors that everyone will experience at some point in their life, such as their age.

Examining this issue carefully in her book Overtreated,  Why Too Much Medicine is Making Us Sicker and Poorer, Shannon Brownlee points out that:

Today, the number of tests has exploded, and doctors no longer just treat the sick but instead go looking for disease among the well. (p. 200)

Why? Looking for disease so you can catch it before it becomes a big problem.  At least that’s the argument. But it’s not the end of the story.

The increase in testing has caused another phenomenon.  In his Op-Ed piece in the L.A. Times (May 6, 2011) Dr. H. Gilbert Welch argues that, not only testing but “treatment thresholds are too low.”  He goes on:

We look harder for things to be wrong.  We test more often, we are more likely to test people who have no symptoms, and we have changed the rules about what degree of abnormality constitutes disease.

Diagnostic thresholds that are set too low lead in turn to a bigger problem: treatment thresholds that are set too low.

This means we are treating as disease conditions which we used to consider normal.  This triggers a whole host of problems for our medical system which are now coming to light.  But more importantly, Brownlee points out:

…many other tests, which have their place if a patient has symptoms, have had the perverse effect of benefiting only a small minority when they are given routinely to apparently healthy people in the name of prevention — while exposing the majority to invasive, often dangerous treatment they don’t necessarily need. (p. 200)

Even the humorous comment, “Now I can do all the things I did before, but with the assurance that I am doing them while medicated,” is offset by the serious claim that health is not benefited by over treatment.

Simply put by Welch, “low thresholds have a way of leading to treatments that are worse than the disease.”

These revelations might well be disconcerting to those relying on multiple medical tests for reassurance that they are healthy.  There is an alternative worth considering.

Richard Schiffman writes in the Huffington Post (January 18, 2012) that …

“regular prayer and meditation has been shown in numerous scientific studies to be an important factor in living longer and staying healthy.” Schiffman discusses the underlying research and surveys that support this conclusion.

I’ve found that to be true. Regular prayer, along with well balanced living, has been invaluable in maintaining my health without a host of low-threshold medical tests.  Mary Baker Eddy figured this out over 140 years ago and wrote about it in her book Science and Health.  I daily use prayer and her system of health maintenance.

The test that I’ve found to be essential is an examination of my consciousness.  I look to see what unhealthy attitudes are lurking there, and treat those–with dismissal. There are no negative side effects from finding and eliminating unhealthy thoughts. This process doesn’t result in a cure worse than the disease.

This form of health care can effectively achieve and maintain health.  That’s been my experience for many years.

Yes, there is danger in lowering the threshold for medical tests and treatment.  But I’ve yet to find that there can be too much prayer and reflection as long as it leads to real change in my thinking and my life.