Having nurses measure happiness at each check-up is simply not practical because of its obvious subjective nature.
If the first and second eras of health are communicable disease and chronic disease, according to the article, maybe the third era can focus on wellness, aimed towards maintaining health before getting to a disease state. For example, Metabolic Syndrome is not a disease in itself, but a list of conditions an individual has (increased waistline, high blood glucose, high blood pressure, etc), that are associated with increased risk of more serious degenerative diseases, such as cardiovascular disease. If we approached measurement of health in this manner, we could have a list of healthy habits that individuals participate in, i.e. exercise, consuming a variety of food groups each day, not smoking, etc. For each additional healthy habit, the individual could be rated as having X% reduced risk for various diseases associated with different lifestyle habits. Also, if a patient is otherwise healthy according to current standards but does not practice any number of these healthy habits, maybe the doctor could refer them to specialists in nutrition, exercise, or other wellness-associated activity, similarly to how doctors can refer patients to other specialized doctors.
Physicians already have those resources to refer patients to dietitians, social workers, psychiatrists, group therapy or even community groups. There are plenty of community resources available, especially in a large city such as Los Angeles. We have all sorts of organizations that provide group meetings or other such activities for people of all ethnic backgrounds, religions and issues like postpartum depression, obesity. The issue really becomes two-fold. First is the actual level of motivation on the part of the patient. Physicians can refer patients all day long, but not everyone actually participates. Second is the ability of patients to actually take advantage of those resources. For example, a single women with two children who works two part-time jobs. When is she going to have the opportunity to take part in any of these resources?
ReplyDeleteAlthough physicians may have those resources right now, any individual who is considered "healthy" would have to pay the costs associated with seeing a specialist like a dietitian. I think many would agree that the current health care system does not foster a desire for a majority of healthy individuals to seek out resources like these to "maximize their potential for living". Things like eating healthier food or having a gym membership are seen as luxuries to many people.
ReplyDeleteAlso, while patient motivation is certainly a factor, 100% participation shouldn't be expected. There are definitely people who have the mentality of "if it's not broken, don't fix it." But, if the level of participation in these various resources does increase at any significant level, as a result of a physician's recommendation, then it should be considered effective.
And, for a single woman with two children and two jobs, part of the plan for an individual like this to lead a healthier lifestyle should certainly include some type of afterschool program, daycare, or baby sitter, to allow her to include other resources that would help promote mental, social, emotional, and physical health for her. How that would be paid for is another issue entirely.
Since the third era is focused on wellness rather than getting communicable and chronic diseases under control, I do think creating a health care industry that does have a focus on providing aides to wellness is important. Many healthcare providers do offer courses and support groups for wellness and social support, however, our society functions under the "If it's not broke, then don't fix it" mantra. For example, as a child we all attended yearly physical exams, also known as wellbaby visits. However, once we transition from the pediatricians office to adult medicine, unless you are female, those yearly visits are not necessarily as encouraged.
ReplyDeleteAlso, previous comments have mentioned utilizing nutrionists and other specialists more. In reality, referals to these programs are often done on a need be base or when someone has a medical condition this will benefit from this type of counseling. Healthcare providers should offer this type of programs to all their patients to utilize throughout the year, not just the chronically obese or people with other specific ailments. If we are truly going to adopt the third era of wellness, these types of programs should be expanded to be used by all patients without a referral.
Because we live in an economy that is unstable right now, the luxuries of attending gyms and other programs is not as easily accessible. The third era of wellness should transition healthcare providers to offering similar type programs as part of the high premium many of us pay. I'm not saying that Kaiser should add a gym to their facilities, but offer free classes on how to utilize community parks for exercise or hold weekly yoga classes on the front lawn. These are easy things to add that would send the message to the community that going to the doctors can also be for wellness, not just for when you are sick.