America's Healthcare Crisis, Part I

March 01, 2009
Ashoka Chakra

A few months ago, one of my neighbors (lets call him Q) was driving from Pennsylvania to New Jersey on I-78 when he began to feel unwell. He felt weak and nauseas, and had a headache. Q managed to work half the day, but then his condition deteriorated. After calling his wife, he drove home, without informing his physician about his condition. The wife waited at home, wondering whom she would hear from first – her husband, the emergency medical services, or the highway patrol. He did end up reaching home safely, without causing a wreck or injuring other drivers on the highway, but they ended up going to the emergency room that night.

The story gets more fascinating at this point. After many tests in the ER, Q was hospitalized. He had a history or high blood pressure and was about 100 pounds overweight. Disregarding his doctor’s advice to loose weight and exercise, he had carried on, concluding that he was too young to worry about strokes or heart attacks. After all, he was only in mid-thirties. But Q wasn’t too young, and he ended up with a stroke. Fortunately for him, there was no permanent neurological damage. Unfortunately for him, the tests revealed another problem – he had a mass in his neck that was detected by computerized axial tomography (commonly known as the CAT scan). That it required a CAT scan to identify a mass that should have been detected by a physical exam is a point that will be addressed in a subsequent column, but to cut a long story short, he was suspected of suffering from a lymphoma. Many tests followed, most of them unnecessary, with attendant expenses and anxiety, till he was proven to be cancer free. And then, Q lost his job. While the company laid-off others as well, undoubtedly his case was complicated by medical bills. A few months after this, I asked Q what medications he was on, and he looked at me with a vacant expression and said, “I don’t know.” He now has trouble finding a new job that is commensurate with his experience and training. Part of the reason is the health care premium his new employer would have to pay.

This story reveals several aspects of what is wrong with the health care system, such as the attitude of patients, doctors, lawyers, and insurance companies. This column addresses the behavior of patients.

We in America have gotten used to being taken care of by someone else and over a period of time, have lost the sense of responsibility. Health has become the responsibility of everyone but the patient. However, shouldn’t health the patient’s own responsibility? Why should the government or a doctor be responsible? A doctor IS responsible for providing guidance and counsel. However, the ultimate responsibility is that of the individual. And if that individual chooses to live on a diet of hamburgers, fries, and considers watching sports on TV the best way to exercise, is it a surprise that obesity, diabetes, hypertension, and heart disease ensue? While suing physicians may enrich John Edwards and his ilk, it won’t solve the problem.

Avoiding disease should be the first health care priority and responsibility of an individual. That includes proper diet, exercise, vaccinations, and common sense actions such as wearing helmets, seatbelts, avoiding unprotected sex, etc. It is acknowledged that genetics, age, and environmental influences affect even those who are careful, and that is where the second priority comes in.

The second health care responsibility is to understand and educate oneself to disease(s) that afflict a person and also to familiarize oneself to the therapeutic modalities. If an individual has hypertension, s/he needs to know about the disease and the therapies available (which includes drugs and non-drug related activities such as diet, etc). Unlike Q, who did not his medications, a responsible individual should not only know the names and doses of the medications but also the side effects and interactions with other medications. In the Internet era, knowledge is not hard to come by and is no longer an excuse.

The third health care responsibility is to follow instructions meticulously. If exercise is advised, it should be followed. If an antibiotic is prescribed, it should be taken as prescribed, and not stopped half way through.

By taking responsibility for our own health, we can help save the health care system from a catastrophic breakdown.

Favorite books: Germs of War (Ketan Desai), Moby Dick (Herman Melville), Sherlock Holmes Treasury (Conan Dolye)
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March 1, 2009
01:44 PM

in health
in happiness
in sadness

the truth remains in your words:

...the ultimate responsibility is that of the individual.

March 1, 2009
04:30 PM

Ashok, does the current medical system or the society promote prevention and reward it? It's all about freedom to do and live as one wants while ignoring the consequences, and then popping a pill to "cure" such physical and psychological ailments. Besides, it wasn't that long ago that doctors in the US were selling cigarettes while ignoring the health risks. Whom to trust?

Prevention necessitates placing some limits on one's behavior/actions, but would that be considered progress in today's societies where everyone wants to be a rebel?

And the alternative health modalities - which do promote prevention over cure and are holistic in their approach, are viewed with suspicion by the scientific community as their science, which believes in breaking down everything to its smallest unit, doesn't validate the theories underlying such modalities.

Ashoka Chakra
March 1, 2009
04:56 PM

You are correct in both of your first two paragraphs. That is why prevention is so difficult in the US.

Regarding alternative health - it is a burgeoning field. Major universities such as Harvard have departments devoted to Ayurveda, etc. Some major pharmaceutical companies also look at alternative therapies, though thankfully the Indian government has stymied their efforts (and prevented patent theft).

Suresh Ram
March 2, 2009
10:35 AM

Eastern Countries has Family System which takes care among other things HEALTH also. USA and West destroyed the Family System and now screwing up itself and looking for alternative model!

""By dollars paid, the U.S. Social Security program is the largest government program in the world and the single greatest expenditure in the federal budget, with 20.9% for social security and 20.4% for Medicare/Medicaid, compared to 20.1% for military expenditure. Social Security is currently the largest social insurance program in the U.S., constituting 37% of government expenditure and 7% of the gross domestic product and is currently estimated to keep roughly 40% of all Americans age 65 or older out of poverty."

March 5, 2009
01:28 AM

This is interesting: http://www.nytimes.com/2009/03/03/business/03medschool.html?em.

The rot seems to be running deep.

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