After a lot of discussion, collaboration, expression of thoughts and ideas, we're now poised to take our ideas regarding a new healthcare paradigm and put them into a definitive form. The purpose of this experiment is to create a vision that is well-enough defined that someone could, if they so desired, actually put it to use or at least utilize it to provide a significant inspiration for what they would like to create in their own town or community.
I know that putting things to form can be a little tricky and so I'm going to layout a methodology here that I realize is a) not perfect; yet b) is based on an attempt, at least, to be sensitive to the various styles and approaches to which the group who's come this far on this endeavor, seem to respond well. If the approach I'm using isn't ideal for you, I hope you'll pardon its less-than-ideal nature, and share your thoughts, ideas, and visions with us anyway.
The form I'd like to use is the following:
For each entry you make, please choose an area of the vision upon which to focus (i.e. focus on an area like one of the following: the exterior appearance of the center, the underlying philosophy, the various fields of service that would be available, the interior space, how the center handles its financial needs, patient education, community outreach, etc.).
There are numerous areas from which to choose and many not named here. There are also a variety of ways of naming categories that might provide a new linguistic angle that will have us see or think of the area differently or in a totally new way. I want to strong encourage us to feel free to be very creative in this regard.
Since I would like to combine our work into a single document at one point that I'll re-publish on this site as a collective work, I'd like to ask for a small favor. At the beginning of your comment, simply begin by labeling the area your particular post will address as follows:
INTERIOR SPACE:
I see an interior space that is... (or whatever language you'd choose).
The primary point is that the focus area will be in caps and that the commentary will be 2 spaced lines below. This will allow for all of us to easily read through comments and find the material we're looking for and it will allow me to capture the content later and be able to work with it much more easily in order to prepare a collective piece to re-publish here.
One last detail. Rather than disagreeing on someone else's contribution... just add your own vision about the same area. What we're going to do is look for an additive process... or a collective process. Someone may write a vision you think is totally wrong. That's okay. Just describe your vision of the same category in your commentary. Later, we'll take a look at the various versions of each area and see what we feel accomplishes the overall vision the best.
Remember, we're looking to accomplish a couple of goals with this process:
1. Create a well-defined, exciting, invigorating, fresh, practical, and solution-based, vision for a wellness center; and
2. We're looking to have fun in the process (we don't have to create the perfect vision... just something that provides a good springboard).
I'm very enthused to see where we can take this together. We've assembled some good minds with good intent. Feel free to invite others to this process and contribute to as many different areas of focus as you'd like as many times as you feel would be useful.
Let's create something amazing together!
Thank you,
Christopher
P.S. As always remember that to see the comments in a separate window, click on the "Comments" link. To see the comments in the body of the topic, click "Links to this Post"
Views of those commenting have not been checked for accuracy and do not necessarily reflect the views of this blog publisher or his associates.
Saturday, July 21, 2007
Genius in Action -- Creating a Model for a Community Wellness Center
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Yay!! I'm first... okay, so here goes.
ReplyDeleteEXTERIOR ENVIRONMENT:
I see a building that beautifully fits within its community -- one that is surrounded by gardens, trees, grass, benches -- a park-like setting that feels like a Utopian place of learning, wellness, healing -- somewhere you'd like to spend time (if any of you have visited the new Getty off from 405 here in the Los Angeles area, it begins to approach what I envision in terms of creating a beautiful feel).
I've also envisioned that the building is perhaps circular with an interior center and spokes that extend out from the center (for various areas of specialty -- maybe one for children, one for infants, one for adolescents, one for adults, etc.) For sure, though, I see something that is round or has curves as opposed to hard corners.
The outside environment should flow right into the inner environment... like the two are one thing, not separate. I'd also like to see all underground parking to avoid the unsightly vision of cars and to allow the building to be surrounded by beauty.
That's what I dreamed of last night. (I'm really excited to be doing this with all of you!)
Love,
Jonnie
P.S. I think I did the format right. It kind of reminds me of a screenplay format, if you've ever seen those. I can see how it will make it easier for all of us on this project.
I'm new as a contributor, but have been observing your group for a while now. I'd like to take on one area, I've not heard mentioned in regard to community outreach.
ReplyDeleteCOMMUNITY OUTREACH -- THE WIRED WELLNESS COMMUNITY:
As a tech exec, this may be a natural default, but I would envision that everyone who belongs to this Wellness Center (or wellness community) also be a member of an on-line wellness/health education community. Membership would be free and medical staff and others (including patients) could update portions of this information in a wiki-format.
Members would be encouraged to develop new formats and to create communities online around certain wellness opportunities or health issues.
A key to creating an educational environment has to be to allow easy communication and sharing of knowledge and information from everyone in the community.
Everything from appointments to doctor communication, etc. could be facilitated by this means -- not as a replacement for face time, but as a significantly improved modality for on-going interface and connection.
Childhood education and adult education could be developed (and/or accessed from existing online programs) to make the education process engaging, interactive and effective.
Inside the clinic, the availability of screens and keyboards in an education center could also assist in allow medical personnel to make prsentations to their patients at a seriously advanced and more effective level.
The possibilities of this idea are impossible to detail in full expanse at this point, but if you let your mind open up and anticipate all of the healthy and productive possibilities, with necessary controls to mitigate against the downsides, it'll blow your circuits -- and fast!
CS, not sure if you watched any of the Aspen Institute's Idea Festival this week (or perhaps participated in it), but it was interesting that though they struggled around the topic of healthcare (they didn't really have time to make it past the second step of our early exercise, it seemed) and described some of what you just did in regard to public education, no one mentioned this tool in terms of healthcare. Great addition to the mix!
ReplyDeleteOkay... so I'm not sure what category this goes in, but I'm going to give it a try because I've been thinking about this a lot over the last few days... and my ideas won't be sophisticated or anthing... but I'm going to name this category, what the category is named on my new cell phone.
ReplyDeleteADDED FEATURES
FITNESS CENTER: I think of a wellness center as having things like a gym or fitness center. And there would be instruction about how to really have a plan for exercise and fitness that you can truly manage. There would equipment and trainers and you could score good deals on home equipment. But mainly it would be a community of people working together to be healthy. It's like you would see them around town and say, "Hey, how's the program coming?" you know...
COOKING-NUTRITIONAL CENTER: My girl friend is nuts about cooking. She watches the Food Network more than any other channel. I can imagine a place with a great kitchen where they show you how to cook meals that taste great and are healthy for you (including raw food meals -- cause I am totally digging on those). But this part of the center would also teach people about how food and their body work... so that people would become educated eaters, instead of zombies to the food commercials. And like somebody said... they'd drill into us the importance of H20 big time.
Those are two "added features" that I think people of every age group could really get into and get a lot out of.
Quick post... only a moment available before dashing back into the world of contradictions and meaningless principles.
ReplyDeleteComing up with the right name for the section I'm about to describe will need some work, but I intentionally avoided using the term, "pharmacy," as it carries so much well-earned baggage.
SUPPLEMENTS AND WELLNESS AIDS
I'm picturing an area that is full of the best natural products and supplements (only those that are truly certified) and the normal variety of less natural remedies (drugs). While the drugs would be behind glass with a pharmacist (as is currently required), I also envision that supplement advisors would be available in front of the glass, as well, and would be able to interact with those visiting the center (yes, at least one of them would likely have to be a pharmacist).
They would access the computer screens that our new contributor mentioned and would seek to educate, help people make informed decisions, double-check for any cross indications and so forth.
What I'm looking to see is an area that feels inviting (No doubt, Jonnie can better describe the aesthetics of this section should she wish to try -- and I believe that it is also an important component).
I'm focused, however, on a trying to come up with a cross-disciplinary approach that provides good balanced information and increases knowledge (so many pharmacists try to do this now, but they're hands are tied due to their behind-the-counter circumstances). So leave some behind the counter, bring some out into the public space, and have natural supplement specialists and pharmacists working in tandem to ensure the most holistic information is provided.
Naturally this section would also rely upon the medical advisors utilizing the same balanced approach (as BKO said, staring with the least invasive approach first -- I'm hoping to hear more about your thoughts on this section BKO).
Well, my contribution is not a masterpiece, but it's a start. I'm hoping that my initial kick-start here, will lure BKO into adding their thoughts, as I suspect their experience in this realm will certainly exceed mine (which is sorely limited by my lack of experience "outside the industry").
Now as to the economics of this section -- I'll add some thoughts on that dicey aspect, later.
That's all for now.
BA, just wanted to drop a quick note to tell you that I got your message, and I'm really looking forward to engaging this, but I want to let it marinate for a little while before I speak. I think you're right on, and you are correct, the two things that are most important to me are:
ReplyDelete1- The issue of starting with the simplest, least invasive options first, which I think will provide a lot of built in cost controls, just by definition.
2- The idea of genuine collegial, patient-centered cooperation between pharmacological, herbal and nutritional professionals is something that hasn't been allowed to mature at all, for all the wrong reasons. There are loads of crap on both sides of that equation that have led to that situation, and that's what I need to spend a little time thinking about from the positive perspective so I can meet you at your questions with all my bags packed. Give me at least until this evening or tomorrow. I think this is going to be fun.
BA, just a quick comment or two.
ReplyDeleteI am really enjoying your ideas about a more well-balanced healthcare model. I look forward to hearing more in this regard.
I would, however, like to invite you and all of us to keep our comments focused on solutions and to avoid looking back and/or taking pot-shots at the existing system. I think that keeps us stuck in the past and since this isn't really a debate format, it doesn't really allow any counter comments that would balance a dergatory point of view. (Let's keep it fair and above the belt, as the referee says.)
As SB said in her earlier comment, it's onward and upward... or was it "full steam ahead". Anyway, you get the picture.
Thanks!
his comment is a collaborative effort based on a discussion DJ and I had last night.
ReplyDeleteECONOMIC MODEL:
We're going to base this portion of the model based on the premise that the wellness center and everything within its reach functions as a non-profit. Now, to be clear, we don't mean it loses money or is in the "red" all of the time. What we mean by non-profit is that it is a well-run, healthy organization that churns any money that would normally be profit back into the organization.
As we discussed previously, we also are running with the notion that this center is owned by the community itself (similar to a credit union model). The center could be built with dollars from investors, a community bond, a sales tax initiative or any of the other methods we discussed.
DJ also felt that if the community improved its health to the extent that their contributions were greater than the cost of servicing the community that a dividend of sorts could be paid back to the community members.
The details of that type of program would obviously have to be worked out, but the philosophy of the community being, in essence, stockholders in their own center is attractive to us.
What we envision is that anyone in the community can attend the center without charge for primary services (because the money is coming from community already in terms of a small sales tax increase or something of that nature). We would propose that fair and reasonable charges would be levied, however, for truly elective services and for most products.
Regarding products (traditional and supplementary), we would project a model similar to what large chain stores and coops are accomplishing in that they are able to sell their prescriptions (and we would add supplements) at a flat rate price structure. This would obviously require some negotiation or some type of cooperative effort, but we believe it could be accomplished.
An additional idea which DJ added previously was the idea of a community wellness savings card. The idea here is that one could use this card to cover expenses not covered under the community plan.
We've also thought of methods of self-insuring the community by means of secure investments or other means whereby a pool of money is created from the allocated taxes and/or additional revenue. A portion of this pool would be set aside as a fund to provide for circumstances where catastrophic illness or other serious circumstances occur. We see this as a means of the community ensuring its own sustainability in terms of the center.
DJ also brought up the need for wellness center members to agree to a healthy living plan (diet, exercise, weight management, drug use restrictions, etc.) in order to have all the benefits of the center paid for. I'm not sure just how to manage that idea, but his feeling was that we have to begin to understand and be responsible for our impact on the whole community, not just ourselves.
This is merely a beginning, but we're quite enthused about the possibilities. We're obviously very open for help and additional suggestions to expand and refine this area further.
As a one who espouses transpersonal psychology, my comments may be seen as self serving, but I'd like to add it for your consideration.
ReplyDeleteMENTAL/SPIRITUAL HEALTH
I believe, from my work over the years, that while nutrition is certainly critical to one's overall health (I am of the opinion that one who opposes such a notion has their head stuck in the sand), I also believe that the connection between mind/spirit and body cannot be ignored.
One of the most effective methods I've witnessed in terms of overall health, is to also teach and train individuals to care for and nurture their own mental-spiritual well being.
I would include this component as an integral aspect. I would see all healthcare advisors (medical doctors, nurses, naturopaths, counselors, spiritual advisors), working together with patients in the same fashion as the team-based approach used to solve problems and create solutions in numerous other types of organizations.
Like others, I extend the opinions and input of the rest of our contingent here to add to or improve upon my suggestion.
I so totally agree with you Dot P. Having spent time with people in their most critical times I found that a person's mental, emotional, and spiritual health and resources were so vital to their surviving their circumstances.
ReplyDeleteNot every nurse saw our role as making sure that those aspects were nurtured and attended to. To me, though, it was often the difference between life and death -- and such an important part of how I could be a healing influence for them.
I often have wished that our system could foster those essential aspects up front as an integral part of the wellness process. And here you go... that's just what you described.
Beautiful!
Love is the Only Power,
Jonnie
Thanks, Chris, for the reminder to keep it "above the belt." I have a tendency, some might say, to get off track on issues where I have strong feelings.
ReplyDeleteMy comment that follows won't be profound, but I am endeavoring, nonetheless, to continue the discussion around the economic model because I believe it to be the most challenging. With that in mind, I'm going to add a few more thoughts for everyone to chew on:
ECONOMIC MODEL
First, I want to acknowledge SB and DJ for their work on the economic model. I would also suggest that the entire wellness model needs to be based upon a non-profit approach. To reiterate their comment above – that does not mean that there's a loss of money, but merely that any profits go back into the system to serve the people.
In my vision, whether it be a hospital, clinic, an insurance company, a pharmaceutical company, a supplement company, etc. a non-profit status would be best in the long run.
As was mentioned by one of the contributors somewhere in a previous topic (which I could not find because those previous topics are no longer there?), we currently consider electrical power, water, natural gas, etc. to be public utilities. Why not healthcare? I can think of no more basic human necessity.
The credit union model, wherein the members of a community actually own a clinic, is a very interesting idea. I think that this model could be improved, however, by also adding the oversight that can accompany a public utility. This does not mean that the healthcare organization, insurance company, etc. could not be private or owned by a community, but rather that it be monitored and regulated by what's in the best interest of the public for which it exists to serve.
But here's the biggest challenge, in my estimation:
So long as we continue to have the inherent conflict of interest between patient care and stockholder value, the stockholder will win out far more often than not. Some may disagree on the basis that patient focus is always what's best for an organization in the long run. But I would suggest that in this day and age, stockholders are far less interested in the long run than a) they used to be years ago; and b) they need to be in order to ensure that organizations will not be faced with this conflict of interest.
Therefore, I believe that there is a need for these organizations to be regulated -- even when the "stockholders" or "owners" are a community itself.
Your thoughts and ideas in this regard would be genuinely helpful for me to take the next step in my own thought process. If someone has a more enlightened and effective suggestion, please make it. I would be most grateful.
BA, thanks for your contribution. While I believe we recognize the difficulties the current economic model may present, I'm not sure we have a fully viable method for replacing that model with something that will actually work. I look forward to the financial underpinnings of this entire idea being explored more deeply, as you suggest.
ReplyDeleteMy desire, would be to see us look at the economics from a small-town level, rather than the national level. I have a hunch that's where the secret may await discovery.
Also, to your question regarding the past topics on healthcare, I removed them from the blog because I felt it would best serve our collective interest to draw from a fresh spring -- to borrow a metaphor -- than to be dipping back into our past discussions.
My apologies for any inconvenience that may create for anyone. If you truly need to access any of that information, please let me know, via email, as I can access it off-line and send it to you for your own use.
Greetings! Having watched your discussion with great interest, for some time, I do believe that I may offer something of value to your discussion. I would categorize my contribution as being that of fundamental operating principles. I will lay out what I believe the necessary fundamentals are and then compare it with what I believe the current system fosters instead.
ReplyDeleteFUNDAMENTAL OPERATING PRINCIPLES:
I believe there are three fundamental principles that need to be addressed in order to cure our current health care delivery model (the reverse of which has resulted in the health care crisis we are experiencing today).
Fundamental Principle #1 - The economic incentives of the stakeholders must be aligned.
The current system rewards providers for the quantity, not quality, of care delivered. This allows providers the ability to offset the negative financial impact caused by reduced reimbursement rates and uncompensated care. Protection from malpractice claims is another motivating factor for providers performing/ordering unnecessary exams and procedures. “To avoid predatory lawsuits, surveyed physicians admit to adjusting their behavior to minimize their risk. Nearly 80% of doctors say they have ordered unnecessary tests and 74% say they make unnecessary referrals to specialist”
Fundamental Principle #2 - Accountability
Presently, in most all cases, patients are not accountable to adhere to their treatment plans. Patients are expected to self-manage chronic conditions and rarely comply with the prescribed plan. Poor adherence to treatment protocols remains a major factor in the advancement of chronic disease to a more acute and costly stage. Consider for example, on average, patients prescribed lipid lowering drugs remained without filled prescriptions for over one-third of the year. In fact, only about half of the patients are still taking the prescribed lipid-lowering medication six months after they are given a prescription, and only 30-40% are taking them after 12 months.
Providers are also not held accountable for the quality of care they deliver. Despite the rhetoric from insurance companies and the government regarding “pay for performance” initiatives, implementation challenges will dilute the impact to a negligible level.
Fundamental Principle #3 – Proactive Not Reactive.
Providers in the current system are paid to treat medical conditions. They are not paid to keep people healthy. For the providers in the current healthcare delivery model, improving the health of a population through preventive measures is bad for business. So long as this fundamental principle exists as is, substantial amounts of money will be spent on physician and hospital services that are avoidable.
I am most interested to hear your thoughts regarding these principles. Are they in harmony with your vision?
This comment is as much a question as a proposal. I think it would best fall under this most recent category of fundamental principles.
ReplyDeleteFUNDAMENTAL PRINCIPLES:
How do we put the responsibility for healthcare in the hands of the consumer?
How do we determine when a person is ready to make a healthcare behavior change?
Bottom line: I would propose that people change when the benefits of changing a behavior exceed the resistance – it’s an economic model.
Accepting responsibility for one’s own healthcare and making the necessary behavior changes that can impact health are all part of this self-management.
Diabetics who measure their blood levels, asthmatics who use peak flow monitors, overweight individuals who begin exercise programs and choose healthy food options are just some of the ways that this self-management is occurring in the industry currently – some insurance companies and disease management companies are beginning to incorporate this type of self-management into their program design. Clearly there is a long way to go, but I'm not one for doing away with insurance, but rather re-modeling it to fit the need it was originally created to meet.
Health coaches, web-based health information and interactive voice response systems are all emerging as new tools in this self-management arena.
Someone in one of the early topics I remember reading, brought up the topic of self-determination. I agree with their emphasis and believe that with that self-deterministic freedom comes an equal responsibility from the patient (and yes, of course, the medical establishment as well). When we, as patients, take full ownership of our circumstances, we will then demand the level of care we will have earned (and perhaps should have received all along).
One of the aspects of this blog that I have enjoyed is that people are seeking solutions, not just complaining. That's the power of self-determinism at work.
I'm the more conservative guy in this bunch (or so I believe). But something I've appreciated about this forum is that it seems to be focused on a solution not just defending a position.
ReplyDeleteI say all that to say this. I'm all over self-determination, you have to know that. But you can't fully have self-determination, if people don't have the power within their reach to make those kinds of deterministic decisions.
FUNDAMENTAL PRINCIPLE:
Somehow, someway, we've got to figure out how to provide basic healthcare to every citizen of this country. I do not believe we can continue to make excuses and pretend that it's okay that we let people die because they can't pay or their plans don't cover the necessary procedure.
My fundamental principle -- everybody has basic coverage -- men, women, and children. Anything less, in this age, in the wealthiest country in the world is, in my humble opinion, barbaric.
Now I realize that can be viewed as a position, not a solution. But I believe that's the solution we have to be aiming for or we'll just re-dress the current system in a cuter dress. And that won't due any longer. At least not for me.
Want to start out proving it’s do-able in a community? That's great! Let's create that model. I just want to make sure the ultimate goal is that whatever we create can be applied over and over again in a sustainable manner.
I want to wade into this discussion on fundamental principles, because I believe when we start talking about self-determinism, we are simultaneously addressing the economic model.
ReplyDeleteTo be clear, I’m not going to propose a solution at this point, but I would like to offer some points for everyone’s consideration. Why? Because, if we’re not careful, we could end up going down some roads that we do not really intend to travel.
FUNDAMENTAL PRINCIPLE CONSIDERATIONS:
The underlying belief that has historically accompanied self-determination is the idea that if individuals bear more financial responsibility for paying for their healthcare expenses, they will become better consumers, be more motivated to take better care of their health and make more informed healthcare decisions. I am thus surprised to hear it promoted in a discussion that is apparently headed toward a community-funded model.
Why am I surprised? Because the current conversation only appears to take into account one aspect of ‘self-deterministic consumerism.’ As a term, ‘self-deterministic consumerism’ has two definitions that are nearly opposite in meaning: (1) the emphasis of advertising and marketing efforts toward creating consumers who will make choices based on brand loyalty and economic imperatives; and (2) protecting the rights of consumers by helping them make more educated decisions.
In the context of healthcare, these two definitions cannot be considered mutually exclusive. Rather, they must be simultaneously acknowledged and embraced.
Using the self-deterministic model in a communally funded system, however, will require some genuinely creative thinking. The reason being that one of the fundamental aspects of the model has been removed (direct economic incentive for the patient).
That leaves us with simply the aspect of making an informed decision in terms of the path one will take along the wellness continuum as the only incentive.
On the surface while this side of the spectrum appears to be a clear and simple model, one must also deal with the reality that with the dizzying array of choices and overwhelming information, can the healthcare consumer genuinely be expected to know how to make sense of their choices and, in turn, know how to make the best decisions?
As we approach modifications to the existing modality or generate new models that seek to adopt self-deterministic initiatives that require employees/consumers to take ownership of their health, they – and the healthcare services system itself – will run straight into a fundamental barrier to success. Namely, low health literacy.
To complicate matters, how will one ensure that decisions made by the consumer are also the most effective for the community who is funding the endeavor? If the service is free, why not go for the more assertive treatment, just to be sure?
Bottom line: Any plan that intends to create a more self-deterministic approach to healthcare, which I have heard echoed here repeatedly, must also simultaneously create: (1) a patient education system and an accountability system that requires patients to attend to their own health and education – and that requires the medical establishment to provide such an education before requiring patients to make uniformed decisions; and (2) a means of solving the apparent dilemma that arises when the economic incentive for a patient is removed.
These are some of the more challenging issues one deals with in creating a new model. However, there are some bright people assembled here. How would some of you propose to address these matters?
My friend has asked me to read your words and contribute. He believes a vital part of the discussion is being overlooked to some degree. I must say that I agree with him in part.
ReplyDeleteI will call my contribution ESSENTIAL ETHICS OF WELLNESS
According to my understanding and the understanding of many generations before me the most essential element of health is life force. One must understand this deeply before contemplating other parts of the system. Otherwise one may build an entire system on loose ground.
If one understands the very nature of life force then one understands that it is essential and sacred. If one understands this deeply then one cannot begin to imagine denying others access to knowledge or their culture's traditions of nuturing, sustaining, or preserving the life force in their being.
Why should one who is rich have more of a right than one who is poor to insure that the sacred life force flows freely and purely as intended within the body which it has broght into being? Such an idea is without logical sense.
If a people can agree to the sacred responsibility we each have to care for our own and others' vital force; if we understand that this responsibility is a key to our own health and that of our families, communities, nations, and our environment; then we will know how to make right decisions. The path will be clear for us and each step will follow the other in natural procession.
From this place of understanding, one may then build layer upon layer with each layer adding strength and well being to the whole system and to itself.
Thank you for hearing my comments.
Peace to you,
Trinh
I must say that this discussion, while intriguing in past episodes, has finally taken on a deeper tenor that I find most encouraging. Trinh's comments, in particular, invite us to adopt a fundamentally more sane view of our responsibility -- we are dealing with human lives, not just dollars and cents.
ReplyDeleteFollowing upon other comments added here as well, I would like to add some further considerations to the discussion (and I promise that should I make future contributions they will not be nearly so lengthy).
To stay in harmony with the format, I'll call my contribution,
FUTURE FUNDAMENTALS:
So, what can we achieve within what this group has dubbed the field of wellness? During the second half of the 20th century, the developed world achieved colossal advances in medical innovation focused around two distinct science streams.
On the one hand, pharmaceutical chemistry and related disciplines spawned important new therapeutics, developed by a high-performing pharma industry. On the other, medical devices and instrumentation advanced through precision engineering and material sciences.
Together, alongside improved education and living conditions, these innovations have saved, improved, and extended the lives of hundreds of millions of people. While it goes without saying that millions were also left, the danger still is that the success we have experienced may lock us into thinking that the same model will serve us as well in this century.
A new equation has arisen at the end of the twentieth century:
Longer life X multiple chronic co-morbidities X increased expectations = great pressure on healthcare resources.
These factors have also led to the perception, in the minds of many, that healthcare is one of society's greatest liabilities, whereas our health should be regarded and nurtured as our greatest asset, an undeniable dividend from a knowledge-based society.
Today, almost all our healthcare resources are focused on the treatment of post-symptomatic illness. Our model is based on allowing ourselves, through life-style, environment, latent genetic pre-disposition, or simple ignorance to develop serious disease.
The more sophisticated the economy, the more patients have access to intensive investment to optimize late-stage treatment outcomes. But, this arises at a time when the treatment options are narrower, costlier, and a successful outcome is less likely.
We need to challenge whether this narrow focus on late disease makes best use of our technological potential and is, in fact, the best way to help people preserve their greatest asset, their health.
So, how can we improve the healthcare model for the 21st century? As a prerequisite, we must move to a more geographically and socially inclusive healthcare universe.
The 21st century healthcare revolution can be achievable without any of the physical traumas of previous social advancements, if we are wise. We will need to place greater emphasis on the practical tools to help and motivate individuals to understand and maintain their own health. The keys for me are to adopt a holistic view of the individual’s health and to act early, before symptomatic disease, or the factors that provoke it, are allowed to gain the upper hand.
This is much broader than just genetic-based medicine. It may sound surprising to find that a committed biomedical capitalist is advocating a broader, public health-led model, but this is what is needed.
The early health model is a tremendous opportunity for all contributors to healthcare provision to unite in the design and delivery of new programs to discover and address the causes of ill-health environmental, lifestyle or genetic then address them with the individual before they become intractable, debilitating, and expensive.
We should constantly ask, “How do we take care to the individual?” Not, “How do we bring the patient into an institution?”
We should also think radically about the relationship between the individual and their own healthcare. The 20th century relied upon a hierarchical relationship between a physician and a highly dependent, passive patient.
If we are to avoid an ever-increasing epidemic of late disease, individuals will have to take more accountability for their own health -- something that has been shown to be extraordinarily difficult to do.
Today, students are expected to have knowledge of mathematics, science, humanities, and languages, but health figures no-where. Even a high-performing student, after up to 15 years of education, will have little knowledge of the workings of their own body, of disease processes, and of how to keep themselves healthy.
So, can we contemplate a society where the upcoming generation has a better understanding of their health in a practical, objective, and jargon-free manner? Can we dare to hope for a system that meets the needs of all people as opposed to an increasingly select few?
We must. It is that simple. Though the task may be monumental at first, we must marshal all of our technological innovation, capacity, and ability and combine these with a level of committed compassion that may surpass our current reach. Nonetheless, it is our duty and our call as members of the human race.
Hey Christopher!
ReplyDeleteYou asked me to get my network of world-wide brainiacs involved. I hope we haven't all overwhelmed your site the last couple of days. And you were right; they seem to fit right in with the crew you've assembled already.
So much has been said, I just wanted to add one little note about healthcare (so we can all let it percolate in the back of our minds while we're reading all of these ideas).
In my experience regarding all things new -- in order to truly create something that literally leaps beyond the bounds of our current reality (and by that I mean what we've already actually experienced in a tangible way) -- we have to be willing to explore the previously implausible in order to find where the new world lies.
Albert E said it best... "We cannot solve our problems with the same thinking we used when we created them."
Live, love, explore!
JJ
Hey there, JJ!
ReplyDeleteYou solved a mystery for me. I wondered how all these great new contributors coverged on our site at once. Happy to have all of you! Your spirit and fresh round of thoughtful contributions will envigorate all of us, I'm sure.
Thanks!
Christopher
“Look within all sentient beings, for there resides life. This force is sacred. To nurture it; sustain it; protect it -- that is our life-long responsibility, our highest privilege. Let us never forget this.”
ReplyDeleteAs one who's lived in Europe, South America, Canada, and the U.S. there's something very worth considering when it comes to economics in regard to the wellness model being discussed here.
ReplyDeleteECONOMIC/MANAGERIAL:
The European countries that have successfully established functional national healthcare plans are relatively small in population and geographic expanse as compared to the U.S. This is also true of Canada (though its population is spread out across the southern end of its border with the U.S.)
Brazil, which once has a national health plan, abandoned that plan years back because the increasing population size, combined with its vast geography, made the program too cumbersome to handle without great difficulty. The remnants of that program are a much less effective version of what the U.S. has named Medicaid.
My point is that from a managerial and economic perspective, I believe that any new healthcare model must be established on a community or perhaps, at the broadest, a state-wide basis, as opposed to establishing anything nationally. While a national tax could certainly support such a state-driven effort, the intrusion and bureaucratic inefficiencies that would most certainly accompany such support, would likely not be worth the trouble.
I like the community model you are contemplating. This model, once successfully materialized, could actually become a franchise-able concept from community to community -- with each community owning its franchise. The mutual learning and best practices that could be adopted could certainly help improve this concept for all involved.
Ellio brings up an absolutely crucial point. I think many of the problems we're dealing with are direct consequences of the fact that everything has simply been allowed to become too big, and that the most damaging symptomatic manifestations of that "too bigness" are added levels of complexity, and consequently crippling drains on systemic resource that are completely unrelated to patient care. This point jibes nicely with the previous conversations related to lack of self-determination and low health literacy among healthcare consumers. I believe both of those problems are produced in large part by a system that's administered on far too large a scale to be effective, because at the end of the day, health care is the most intimate and individual of pursuits, and systems that grow too large inevitably have to sacrifice that intimate connection in favor of accomodations to scale. I agree that there will have to be some upper limit placed on the size of a given system in order for it to remain manageable. Exactly what that size will be is yet to be determined, but any successful venture will undoubtedly need to remain local in its scope if it's to be at all manageable. I think that may be a primary reason that a single payer national health policy continually fails to gain support on a broad front in this country. It doesn't happen as much because the idea isn't attractive in theory, but much more because I don't think anyone, right or left on the spectrum, trusts our federal government to do anything but make a hash of the project. When it's cut down to "community" size, the dynamics start to make some sense, particularly when some of the other points recently introduced get added in.
ReplyDeleteExcellent comments, all.
ReplyDeleteI would like to emphasize several points from everyone's contributing statements that bear further investigation and discussion. I see these as fundamental underpinnings to the on-going conversation.
FOUNDATIONAL ASPECTS
1. To echo Trinh's thoughts -- we are dealing with human life. We must maintain a notion of the sanctity of this spirit or life force in all of our considerations.
I believe that we have allowed the sometimes ludicrous limitations of Newtonian-Cartesian thinking to blind us from the possibly limitless opportunities that could be enabled if we were to humbly assume that though we cannot empirically prove a life force exists by means of mechanistic measurements, there is still an entire universe of knowledge to be gained by trying to understand this largely unknown factor.
This open-minded approach is also a requirement, in my opinion, for the healthy interplay between western and eastern medicine (a discipline whose entire system operates quite successfully based upon the premise of life energy or force).
A reciprocal openness will be required in return, as well, if we are to move beyond the demonization of the western approach (no one tends to respond very openly while under attack) and thus be able to optimally leverage its knowledge base and benefits.
2. Three thoughts regarding "self-determination."
a) We must find the balance between self-determination (the freedom to choose) and one's ability to pay. I believe that our solution will be found by intentionally moving beyond the either/or prison created by the discussion around free vs. paid care and looking to find the sensible, but compassionate middle ground. Trying to truly understand the deeper economic implications of such a model may also provide us with a level of wisdom that may evade our normal reasoning.
b) We cannot pretend to put the entire burden for this system upon the patient. That would merely allow our new medical establishment to fade into the background as a mere service provider. The wellness world must be one that expands our notion of collaboration in every direction, with every person involved being a key contributor to wellness. Accountability must me omni-directional in nature to be most effective.
c) The care must be pro-active, not reactive --early model, not late disease model -- focused on the preservation of wellness, instead of waiting until disease sets in.
3. Working to create a plan that is national in scope amounts to a fool’s errand at this point in time. Concentrating our efforts upon local solutions that could be reiterated elsewhere, will keep us focused on our most feasible options.
There is much more depth within each one of our contributions, but I see these three aspects of our discussion as cornerstones.
I'd like to refer back to a very pertinent contribution that came from BKO and Anonymous. It seems like the perfect time to re-introduce it into this conversation:
ReplyDelete********
bko said...
Note: This post is a product of recent conversations between Anonymous and I, so consider it a collaboration within a collaboration!
Anyone who has read my previous posts knows that I possess a formidable bevy of strong opinions (a couple that even make sense!) related to the subject of money and healthcare, but we’re both convinced that we will get absolutely nowhere in this particular discussion if we get stuck debating the merits vs. the evils of profit.
That’s a much heftier discussion than just healthcare and ideologically, it’s just plain radioactive and will burn everybody. However, since no human activity is completely free of some kind of economy, if for no other reasons than that we have to live somewhere and eat something, we can’t credibly ignore the fact that there is an economic aspect even to our fantasy healthcare system.
So, in the interest of continuing to create rather than getting bogged down on the unsolvables, we’d like to offer these observations for everyone’s consideration:
When confronting huge questions, we humans often tend to get overwhelmed by the most “impossible” aspects of a problem and then proceed to stare ourselves blind on them. We get caught up in macro issues like profit vs. non-profit, technology vs. biology, insurance vs. single payer, and yadda, yadda yadda……. All of them are, in and of themselves, too large, too vague and, yes, too polar to allow any new ideas in.
The killer in that one is that the overwhelm keeps us from making a start on the very simple problems right in front of us that can be solved easily and effectively without having to solve the giant issues first. Anonymous stated it well in a conversation this morning when she said “We ask the last questions first.”
What if we started from the other end? What if we simply eliminated the idea of profit as a consideration for now and concentrated instead on identifying the components of a model directed ONLY toward finding the simplest and most direct pathways to good patient outcomes. What if we imagined a system that used patient outcomes as the only viable measure of success? How would that look different than what we have now? Could this function as part of the “other engine” that Anonymous was referring to in her earlier post? Here are some basic talking points we might consider as a beginning.
1 Prioritize the simplest, most pragmatic, time-tested and least invasive choices FIRST, regardless of what healing system they originate from. In our system, can we have the double-blind standard and “the literature” be only one data stream in the greater process of evaluating what works and what doesn’t? Can we also perhaps additionally consider some of what the old country doctor or midwife knew?
2 Slow everything down. Healthcare, particularly in chronic illness, takes TIME. People are complex, and constellations of symptoms barely begin to define the reasons a person is ill. Practitioners seeing too many patients per day can’t possibly enter their cases in enough depth to deploy the best that medicine has to offer.
3 Eliminate the automatic hegemony of any single health paradigm for evaluating best care. Primary care providers, particularly first contact personnel, MUST be trained in the full gamut of available choices and expert in “paradigm triage”, namely, which system or combination of systems offer the right tools for any patient’s particular job.
4 Practitioners (in collaboration with the patient), individually in routine cases, and perhaps in collaboration for more complex cases, determine care. In other words, the people on the ground make the choices about how to proceed toward most efficient resolution.
5 Patient outcomes (according to the patient) are the final test of efficacy. At the end of the day, what actually happens to an individual patient and how they perceive the experience is the only measure they have of how well they were served by the system. In our fantasy system, I would like to see us all join the First Church Of Whatever Works!
6 Replace the idea of “the placebo effect” with the understanding that patients’ own healing potential is the fundamental engine that drives the ultimate success of any intervention from ANY healing discipline. Begin exploring existing methods and creating new, clearly articulated ones for reactivating that individual capacity wherever and whenever possible as part of every healing program.
Obviously, there are many more possibilities, but our thoughts are that starting with the combination of the reaching for the simplest “Occam’s Razor” solution and designing with only patient outcomes in mind might allow us to get this thing a little farther up on its feet before we hit the next set of thorny issues. We look forward to everyone’s thoughts.
********
I look forward to our thoughts as well, as we re-visit their contribution and, in the tradition of circular learning, take it layers deeper each time around.
Well, all you cool cats... it looks like we all came to the right party at the right time. For me, the big question is... since we're all on the same page here... do we need to go deeper on these fundamentals?
ReplyDeleteIf so, let's do! If not, then let's take the next step.
You are all blowing my beautiful mind!
JJ
Thanks to everyone for re-focusing on the real core of what I believe a new wellness model conisists of... people serving people.
ReplyDeleteI love BKO's and Anonymous' words, because we're talking about wholeness... physically, mentally, spiritually. If we lose track of that understanding... which is sooo important... I'm afraid we'll miss the whole point (pun intended).
I get so passionate about this... it's like it's essential for us as human beings to realize this... as if our little community getting this can ripple out to others... and on... and on...
Maybe that's crazy... but that's me. Blonde crazy girl.
Love, love, love,
Jonnie
From time to time, I feel an even larger than usual sense of gratitude for the opportunity to share the richness of this environment. This last couple of weeks has been one of those periods, and I thank everyone again for their contributions. I continue to be challenged, stretched and greatly nourished by all of you.
ReplyDeleteFUNDAMENTAL PRINCIPLES: THE ROOTS OF PRACTICE?
Silvio’s last post encapsulated the heart of what I’ve been thinking about most in recent days, and said it much better than I would have. (I am going to use the masculine article purely as a convention, so nobody yell at me!J) I think his points embody what I feel is a great need to continually till the philosophical soil so that the wonderful ideas being presented will find a fertile environment in which to grow. Chris reposted an old one that Anonymous and I did that sort of moves in related territory, just for the reference for all you new folks. And JJ, I don’t know if I’m correct in hearing a small note of impatience in your last comment, which I understand, but if you (and everyone else) will indulge me just a bit, I believe that taking the time to clarify and concentrate some thought in areas like the fundamentals that Silvio is talking about is very important. That doesn’t mean that the great practical discussions of the last week shouldn’t keep coming, but I believe that even the best problem solving ideas (and we have quite a fund of those developing) can end up being wasted if they arise without a context that provides first principles strong enough to engender their further development. I also believe that if we’re not constantly challenging our own most fundamental beliefs, whatever the area, the danger of getting stuck in polarity goes up exponentially.
I am a practitioner myself, and no one is more interested in better ways to do things than I am. But, I also work in a discipline outside mainstream biomedicine in which effective practice is quickly compromised if it loses touch with the principle of the life force. Removed from that grounding, no intervention works nearly as well as it could. The demands of clinical work constantly challenge my understanding of the established fundamentals, which in my profession are overwhelmingly concerned with the operation of the life force in the world. The effort to balance the demands of daily practice with the rigors of that principle as it’s reflected in my tradition is of paramount concern, and after many years, it’s an automatic process. (There’s MY prejudice, everybody!)
Silvio’s comments contained three paragraphs that I think brilliantly concentrate the root issues and offer a wealth of possibility for furthering this discussion. He wrote:
“ I believe that we have allowed the sometimes ludicrous limitations of Newtonian-Cartesian thinking to blind us from the possibly limitless opportunities that could be enabled if we were to humbly assume that though we cannot empirically prove a life force exists by means of mechanistic measurements, there is still an entire universe of knowledge to be gained by trying to understand this largely unknown factor.”
"This open-minded approach is also a requirement, in my opinion, for the healthy interplay between western and eastern medicine (a discipline whose entire system operates quite successfully based upon the premise of life energy or force)."
"A reciprocal openness will be required in return, as well, if we are to move beyond the demonization of the western approach (no one tends to respond very openly while under attack) and thus be able to optimally leverage its knowledge base and benefits.”
I agree completely with those statements, I would like to attempt to further them by making a potentially radical suggestion in the interest of setting up the coming conversation about which therapeutics should be used in a “new” healthcare setting.
Are we ready, if only for the purposes of this discussion, to look for a way to drop the idea of “western” vs. “eastern” medicine entirely in favor of the more ambitious, difficult goal of finding approaches determined ONLY by successful patient outcomes regardless of what healing system they come from? Do we have the courage to take on the question of how to begin harvesting some of Silvio’s “universe of knowledge” by stretching, responsibly and carefully, beyond the line of that which is “provable” by mechanistic means?
Even with all the anger in the population at present (call it the “Sicko” Factor), I suspect that very few of us, however frustrated we are, would advocate dismantling our emergency rooms in order to have “alternative” programs available. The existing system does many things surpassingly well and has gifted us with a vast base of knowledge, experience and human resource. Much has been eloquently said here recently about the need to intervene with patients before illness has progressed to levels that require more dramatic interventions and focus everything on purely palliative measures. I maintain, from a position of some experience in the matter, that many of the tools we need for accomplishing those earlier, safer, simpler interventions have already existed for centuries, if not millennia, and are only left outside mainstream clinics because they lie outside the current mainstream worldview. They are often excluded because they are not easily understood by conventionally accepted means, not because they can’t reliably achieve their goals. Conversely, we are angry at the existing system because we have noticed that it is in fact imperfect, but although it may have at times claimed more authority than is appropriate, it makes no sense to damn the system wholesale simply because it has not met all of our expectations; expectations which, given the unwisdom of our collective behavior, are often beyond unrealistic.
To be honest, I don’t even really find the “western vs. eastern” distinction very interesting anymore. What I DO find interesting is the idea that the vast amounts of material we are lumping together in those two overly broad categories, when taken together, represent the entirety of the accumulated healing wisdom of the human race. Are we currently doing so well that we can afford reject the potential of any of these methods, many of which have been safely and successfully used for hundreds if not thousands of years, pending their verification by major university studies? Is our modern, rationalist/objectivist paradigm the only standard by which clinical validity can be effectively established? And that leads to another potentially radical question. Are double-blind controlled trials the best and only way to study every method? Or, are there other methods we can add to the process that will safely and responsibly begin to incorporate the pre-scientific wisdom of the world traditions into our wellness center’s activities, not in an isolated laboratory environment, but at ground level, where the issues really are? As we work on the design of this new wellness center, can we change the bathwater and still keep the baby?
When it comes to choosing clinical approaches and therapeutics, by what measurements will those decisions be made, and who will make them? Does expertise in one healing system, no matter how extensive, qualify ANY practitioner to make decisions about the validity of another system in which they are untrained? Further and more generally, is expertise the same as authority? And perhaps most dangerously, are we ready to look at the possibility of surrendering ALL healthcare authority to the service of the life force itself? Would our healthcare look different if every decision we made used that as our first principle?
I am not purposely trying to be snarky or impractical here. In answer to JJ’s question, THIS is exactly why I think we need to go deeper, because as Silvio has pointed out, it’s beyond useless to content ourselves with throwing rocks across the east/west fence. “Eastern vs. Western”, “ancient vs. modern” and “subjective vs. objective” are all just more polarities that chop discussion down and keep us from going beyond our preconceptions. We are searching for the roots of a new paradigm, and paradigms are made up of guiding principles. Often those guiding principles are unconsciously held and completely unexamined by those who hold them, but they are there nonetheless, and I am an advocate of a loving but relentless process of re-examination of ALL our paradigms and preconceptions, all the time.
ORGANIZATIONAL POSSIBILITIES
Now, more practically, the last few weeks have shown that there is a wealth of great thinking out there, and it’s making me dizzy, happily so, but dizzy nonetheless, and I suspect I’m not the only one. Is it time to break things up into some more manageable areas so we can go into more specifics in a more concentrated way? All y’all “brainiacs” are obviously chomping at the bit. Would it be profitable to try and establish some “virtual departments” in order to not only concentrate specific areas of expertise in more technical areas but to also to begin exploring how those areas might establish lines of relationship between the areas that support the truly “holistic” purpose we’re all shooting for? I can see some areas that might be a beginning, but this is obviously just a first attempt, and I am certain that you can all improve or replace it immediately.
I like triangles, for all kinds of weird reasons, so here are three broad areas or “departments” that all of the stuff I’ve read from everyone so far might find a home within, and perhaps might comprise three new strings on the blog or at least give us some guidance as to where to put our submissions so that we can keep them straight.
1- Clinical/Therapeutic
2- Financial/Administrative
3- Patient/Public
Rather than create more windy definitions and make this long post even longer, let me offer an example related to a single hypothetical patient in the new wellness center, who is actually based on a very typical actual patient of mine.
1 – Clinical/Therapeutic: Ms. Jones presents with separate and official medical diagnoses of fibromyalgia, asthma and irritable bowel syndrome. According to her own report, she has received “no help” from her conventional providers, is very unhappy, and is barely maintained on a regimen of medication and severely restricted activity. How is she going to be assessed and who is going to do it? What therapeutics are going to be employed and who is going to deliver the services? Is she going to be evaluated solely on the medical categories in which she’s been placed or are there other areas that need to be considered? Who is going to collaborate with Ms. Jones to develop a treatment program and coordinate the other aspects of her care, i.e. lifestyle changes, etc. How is her progress, or lack thereof going to be evaluated?
2- Financial/Administrative: What happens when Ms. Jones loses her insurance a few weeks into her treatment program because her husband lost his job and now can’t pay? And what about the fact that her debilitation makes it impossible for her to work so that she CAN pay? How will that be dealt with?
3- Patient/Public: Ms. Jones is unable to quit smoking, is living in a verbally abusive marriage, and is unwilling to change her diet. What role might self-determination, patient responsibility, patient education, counseling, and any number of other factors play as she is dealt with in this new setting?
And further, how will all three of these departments interact with each other in trying to help Ms. Jones with her problems. What role do HER decisions play in the situation? In short, if we had a wellness center based on our dream scenario, if the ceiling was off and there were no “real world” limitations, how would we do it differently than it’s being done now? If you are a provider and are trying to help Mrs. Jones, what resources would you like to have available and how would you like to be able to interact with her differently than you can in your current setting? If you’re a patient (and that gets all of us) facing something like this, what would you like to have available to you, and even more importantly, what level of responsibility would you be willing to accept in engaging your healing process?
I’m obviously oversimplifying, but we have to start somewhere. I’m sure these are just a few of the potential questions we have to answer. I’ll love reading what you come up with!
Quick note to BKO:
ReplyDeleteI can see how my comments may have come off as impatient... but, if you could just picture me… chewing my gum a little too fast when I was writing it... you would realize it was actually a sign of my excitement ...that we're even having this discussion with people outside of my own little group... and that we found our way to this little group... of which we're now all a part.
Oh... and BTW (by the way)... as a point of reference ... going deeper is always on my list of things to do.
But what's got me all edgy and typing way too fast now, is the way you're suggesting we go about exploring this topic. The case study you've deftly laid out before us rocks... and I'm intensely interested in both our answers to your questions and our attempt to solve the case study... but even more so... I'm intrigued with the possible questions your scenario will inevitably evoke.
Another twistedly cool factor about this case study... it allows us to go deeper and advance at the same time (and just hearing myself think that... makes me laugh... because that's the kind statement someone makes when they're stoned... and, perhaps regrettably, I haven't been down that road in years).
So here’s a high five to you, BKO! You're a genuine freak... and in our world... that's a very good thing!
JJ
If I may, as one who has been an interested observer of your process, I’d like to interject that a vital component of the model is missing. I am sure you may have alluded to the aspect I will propose, but not specifically.
ReplyDeleteIt is my opinion that the arena of genetics, as it relates to understanding pre-conditions to disease, etc., is an essential element that must be incorporated in any fully holistic model. The more we understand DNA and its complexities, the more we also are gaining the ability to prevent the onset of a growing list of conditions and often life-threatening diseases.
Furthermore, and directly related to the tone and vision of this group, genetic study is helping us act proactively and, when we do have to act in response to the onset or even advanced stage of a disease, we are more regularly able to provide forms of remediation that are less invasive with few if any side effects.
Since my earliest interest in this field, I've always had the underlying belief on some level, that DNA is the mechanism through which the force of life uniquely encodes itself into each individual life form and human being. Therefore understanding how this remarkable component functions has become my life long passion.
Enough said. I don't mean to intrude, but hope you will consider my recommendation.
Thank you.
Stefan,
ReplyDeleteThank you for your comment. I think you've added a very critical component to the list and would love some additional reactions in this regard.
By the way... you're certainly not intruding and are welcome to add further comments any time you'd like.
Christopher
I would like, in response to BKO's questions related to Ms. Jones, suggest that we start with the patient. What does she want to do? Is she coming in to heal, to talk, to relieve stress, to manage her illnesses, to find the strenght to manage the habits of her life....?
ReplyDeleteAll too often we get so busy managing patients and their lives and ailments that we forget the patient in the mix. Maybe we should try, in this our "new" model, to consider the patient first, in which case we need triaging where time isn't so important that Ms. Jones sees her practitioner for but 10 minutes an gets sent to the lab.
As a patient I would appreciate being heard. So that's how I suggest we start. By asking, and listening to, the patient.
Yes, we must always start with patient. One must never pretend to know what is in another's heart. So often the system presumes to know too much. The system must start at the very beginning. The course to be charted, must be set by each person. We who serve are there to assist them on such a path.
ReplyDeleteVery wise to notice this. It is too easy to overlook the essential importance of this very simple, but fundamental aspect. We must adopt this in our model. Very much so.
Thank you for providing this opportunity for me to join you.
Peace to each of you,
Trinh
Welcome, Anonymous! It's very nice to have your influence on this group. The collaborative contribution you made with BKO has stimulated a great deal of conversation in another group with which I also have the pleasure of participating.
ReplyDeleteI am very much in agreement with Trinh, as well, as it pertains to your astute observation. I must also admit to being somewhat astounded at having overlooked this very essential element myself. Though so obviously at the primal core of what we are exploring here, this fundamental approach has been sorely overlooked for far too long. I am going to allow some time for the implications of your comments to take root.
I'm most interested to hear others thoughts in this regard, as well, because I feel like we have just unearthed a long hidden treasure.
Do any of the rest of you have the same impressions?
I know that I often come off as a "light-weight" -- and perhaps I am, as compared with the brilliant minds roaming around this intellectual savannah. But here’s a guess I’m going to make – I’m going to bet that though Anonymous found a direct yet eloquent way to put words around the knowing that the patient's desires are of the utmost important, I would guess s/he has known this and maybe even operated from this place of knowing all along.
ReplyDeleteI know that as a nurse this was always my first instinct -- my intuitive heart's call. Often, though quietly, the patients and I would know that we had a subtle agreement in this regard. We only spoke of it in hushed tones in our hospital setting, however, or communicated with a wink or a shared look, because we believed that this approach would be viewed as foolishness by others who "knew better."
I am totally willing to admit that my experiences may have been mostly based upon my own bias about the system (that's why I left it). But I am also really thrilled, that we are acknowledging in our group that the most fundamental level of service for patients begins by learning from them what their needs and desires truly are, instead of presuming that we know what is best for them.
Imagine how the "patient intake" process would differ if this were our philosophy. I'd love to have us all envision that for a moment.
If we started from the notion that the patient knows... because the life force that flows within them knows... and that our job is to support them in maintaining the integrity of that relationship... and to help provide educational opportunities so that each person can begin to be more and better informed about how their body, mind, and soul all function together… and to provide care, treatment, diet recommendations, exercise regimens… all based on the core knowledge that the patient (and in some cases due to their culture the patient’s family) will know and communicate what is best to do.
What a humbling place for us to be. We would be there purely to serve their journey… to carefully walk and realize that doing no harm also means not intruding upon their soul’s sacred path. I’m awestruck just contemplating the tone of respect and service this would set in our Wellness Center.
Love is Truly the Only Power,
Jonnie
I'm adding this comment so that the energetic JJ will stop emailing me and leaving me voice mail messages that all say, "You have to tell them about your father."
ReplyDeleteMy father was a curandero. Put more in the terms of the indigenous world into which he was born, he was one who knew how to restore people to their intended way of being. In other words, when something occurred which threw a person's body/mind out of alignment with their life source, he knew the steps to take (both in terms of nutrition, detoxification, and spiritual cleansing) to help them restore themselves to their natural state of balance.
My father was tutored meticulously, from the time he was very young, by the community healer (or what some may refer to in North America as the Medicine Man).
Papa's entire world was what we are calling the Life Force. There was no place in his world where this force or source did not exist. To him, it was the foundation of all existence. For him to have even contemplated approaching healing the way we do in the "modern" medicine would have made him burst into uncontrollable laughter. For it would have appeared to him that one would have to have gone crazy or eaten something evil in order for us to forget who we are.
I've commented to JJ several times over the last week that I'm in shock, quite honestly, that some of my cohorts have found Anonymous' comment and Trinh's follow-up as being ground-breaking. And this is no reflection on either the necessity of their having made their observations or the innate value of the statements themselves. In truth, it is simply that I've been deeply disturbed for years now (ever since having re-visited my father’s traditions after having taken an intentionally opposing path until shortly before his death) that we have so removed ourselves from what was once a fundamental understanding regarding our very being-ness that to suggest that we include such an approach in our model seems novel or enlightening.
I won't comment further at this point, other than to say, please let this understanding soak in to your minds. Sit with it, if required, until you know this at your cellular level. You, I, all of us are "Life Force" manifesting as human beings. This reality will always play a determining role in the success or failure of any wellness system to accomplish its intended purpose. It is that simple and that profound.
Respectfully,
Ellio
Ellio, yes. Thank you for your call. Modern medical mind tends to see life source as an element of superstition left over from primitive times. We must prove its existence using the clumsy tools of modern world, they say. When these tools can not measure the very fine nature of life source, people say, See. It does not exist. Just as easily one could say, See. Our tools are not yet fine enough.
ReplyDeleteFor thousands of years my people and their people before them have known of this source. There are things that simple people know that are mysteries to a sophisticated mind.
Still, in our simple way, we continue to this day to better understand life source and its workings. To better understand the endless depth of this knowledge. We may never know fully of its power. But we must continue to seek and study.
If modern world medicine could allow itself to adopt this understanding of the underlying nature of life and pursue its study from this point of view, the power we could accomplish together is most magnificent to contemplate.
I am honored to be able to speak to you and share your thoughts.
Peace,
Trinh
Trinh, Ellio, Jonnie, A.,Silvio, et al, can I just say, HOORAY! for everybody? This particular line is golden. I'm loving watching it unfold. It's the GREAT TABOO and we're finally talking about it!
ReplyDeleteAfter communicating via email with BKO, s/he pointed out, as Trinh and Ellio have, that those of us who are in awe of the notion of life force/patient knows best, demonstrate how far we may have wandered from what many consider to be Existence 101.
ReplyDeleteReading everyone's comments, as I do, before posting them always leads me to some intersting places in my mind. For me, one who has been heavily involved in the healthcare system as a consultant, and as one who comes from a family tradition of organic gardening and natural care (my father's side of the family)... and as one who has sat in and studied various forms of meditation for decades... I, too, am stunned at how seriously culturized or brainwashed I've become in terms of not even expecting that a patient intake process would be founded upon the principles that Jonnie shared.
This whole discussion has made it very apparent to me that knowing something intellectually and knowing it intrinsically are two different things. Understanding the existence of Life Force and even using it to heal, as I have been gifted to do on occasion, are also very different than expecting to see this show up in a wellness model (odd, the unnecessary limitations we place life, isn't it?).
So, thanks to everyone for sharing and for your willingness to challenge current models of thinking (especially mine), to shake the cob webs loose, and to encourage partnership in finding solutions. For me, the very experience of interacting with this blog is transformational.
The discussion continues.
ReplyDeleteUNDERLYING PHILOSOPHY:
Ellio, Trinh, and company. Points well made and well taken. I can relate to Christopher's comments best, since I too "know" better, but apparently have forgotten or allowed myself to be distracted.
I am also well aware, from my own journeys into indigenous areas of the world, of my tendency to find the "primitive" cultures to be childlike (a nice way of saying naive). Meanwhile, they often see us as terribly flawed or as the victims of some strange trance or suffering from a spell that prevents us from seeing what to them is as plain the nose on our faces.
You also have to imagine that if we, who consider ourselves to be on the path of holistic health, are still entranced, how much more so with the rest of the modern world. And it is this with which I struggle. How do we forge this cross-disciplinary path that we describe. How might these seemingly opposite worldviews mingle productively?
Sincerely,
Silvio
Ellio -- you rock, baby!! Thank you!!
ReplyDeleteYou know me. I'm Super Girl... Tigger… and Rocky the Squirrel… in one whacked-out, brainy-girl package… and I just knew it in my bonz that people needed to hear what the heart of that story tells us!
Besides…I just get my groove on every time you talk @ your Papa... because it keeps reminding me that once upon a time [and maybe even still]… as a natural part of every single damned day…we saw it... felt it… like Silvio says… plain as the nose on our faces.
I've been tripping out on some of the other sections of this blog (oh my god... I think some of the lost members of my strange little tribe are wondering around here) -- and there's a guy who calls himself Rizzin -- who writes these amazing poems about IT.
He is talking about the very freaking thing we are! But he sees IT… and I want to get to that place. So -- if you haven't done so already -- check out some of his words -- you owe yourself the favor -- big time! The guy’s a wonder freak!
Silvio -- you ask how do we do it?
Simple [and that doesn't mean easy, our wavy-haired wonder] -- it's by creating one little clinic at a time until we prove it works -- and until people demand nothing less… nothing less! Until thinking otherwise would seem so totally crazy that we’d all burst into uncontrollable laughter!
You all are the coolest!
JJ
P.S. Stefan -- I totally dig your take on genetics. That's exactly how I feel!
JJ, your energy is revitalizing for this old man. I see you as a young tiger. Hungry for knowledge and ready to climb trees even though tigers can not climb. This will not stop you.
ReplyDeleteBut perhaps there is something of your words for us to consider together. A small thing for certain. How does one prove that a clinic focused on life source and serving the patient's path is a thing of value?
This may be a dangerous path to follow filled with many distractions. One may be too worried what others think. One may then not be looking deeply enough into what patient needs.
There is another way. Create this place you speak of. Nothing to prove. Just a place of peace where community experiences wholeness, healing and learns of balance. This path seeks not to prove, but to simply to serve.
People will prove or not prove as they are ready. The power of service will naturally attract its own.
Something to think about. Or perhaps just more of my foolishness.
Thank you for listening to my words.
Peace to you,
Trinh
Hey Trinh... you're the master of the understatement.
ReplyDeleteThanks for catching me trying to prove something... you know scientists... always out to prove something.
Good reminder though... seriously. It's like my rockin' pal, Christopher said... We've been in the world of western mind for long enough... that we just fall in step... without even realizing.
Peace back at ya!
JJ
Trinh’s comment reminded me of something…..
ReplyDeleteI am very inquisitive, and I frequently examine and logically evaluate (whether or not it is necessary!) the validity and reliability and viability of ideas; be it business concepts or other formative suggestions posed by folks I know. I suppose my curiosity and craving for information, explanation and verification are features of my core personality, but I sometimes wish I could leave myself off that hook and see the world from the perspective so often cited by the love of my life….He tends to tell me that he will provide a service, or offer up an idea so that it is “out there” for anyone to choose. When I ask him questions like for instance how come he doesn’t advertise extensively to market his services and maximize his return, he usually responds that he is “just available,” and that those who needs him finds him on their own without excessive marketing measures...He trusts in the life force.
I envy him the freedom he exhibits from the boundaries created by logical reasoning and other equally restrictive ways we have become so accustomed to employ when thinking…And I welcome the wisdom of his old soul…And it is right there where my ponderings met Trinh’s comment. Thank you, Trinh. I needed that.
I like the direction this conversation has taken. Really, I believe what we're talking about is the secret (and I don't mean the lame one) to re-configuring the entire healthcare or wellness model. What we're really getting to when we say patient-directed is patient empowerment.
ReplyDeleteWhether it's finding out what the patient wants; helping to educate the patient; assisting them in becoming familiar with their genetics; following a course of proactive health; or working to create an economic model that allows every patient to have the power to make the appropriate choice for their wellness that is not pocket-book dependent -- all of these point back to the basic premise of patient empowerment.
And yes, with empowerment comes responsibility to follow a course of that leads to wholeness. But I also want to point to a thought from the other new topic. Someone there just talked about community responsibility. That also has to apply.
What do the rest of you think about this idea? I'm pretty much on fire about it.
Well, DJ has zeroed in on what I think most of have been sensing. In order to really advance this topic further, we need to get very clear on just what an "empowered patient" is and is not.
ReplyDeleteWith that in mind, I'm inviting everyone who'd like to continue this discussion to please make your new comments in the new topic, entitiled: "Genius Out of the Box -- Creating the Empowered Patient ."
I've received multiple comments from people reading this blog topic as to its value and insightfulness. I'd encourage them to continue reading and to feel free to jump in and contribute as well. We'd love to hear your thoughts.
Thank you!
Christopher