On the day the President set aside $634 billion for health coverage to uninsured millions, I spoke at a Hospital Foundation dinner in St. Petersburg. I told the audience it was unclear to me how $634 billion was going to fund comprehensive reform. We were already spending 16% of our gross domestic product on health care and it’s estimated that within a decade it would grow to 20% of our economy. At that expense you’d think we’d be the healthiest nation on earth, but we are not (not even in the top 20). What more money will do is continue to support a system based on treating disease rather than promoting health.
The overwhelming preponderance of all health care expenditures goes for the treatment of chronic diseases (respiratory, cardiovascular, gastrointestinal, endocrine, and mental disorders). What the current medical system does best, is treat acute diseases, and not these chronic conditions. To have any real impact on those problems you have to get people to change their behaviors. That means you must spend time with patients to develop a relationship, and inspire them to believe that if they eat better, exercise more, smoke and drink less, and stress less, that they can become the principal agents in their own healing.
We could do this if we change the system, like reimbursing doctors for the time they spend with patients, and keeping them out of hospitals, rather than prescribing more drugs and procedures.
After my speech, I’m sitting on the veranda of a grand hotel overlooking Tampa Bay with one of the attendees. The waiter brings our drinks and my friend lights up a cigarette. Shortly after, the waiter returns and tells her that this is a non-smoking facility. She immediately puts the cigarette out and looking at me somewhat sheepishly says, “ it’s my addiction”.
We have an intimate, heartfelt connection, she is a competent professional, married, and with two teenagers at home. She is capable of “moving mountains” at work, but since she was 17 has never been able to quit smoking for more than three months.
We talked about all the treatment options (many of which she had tried), and the despair at her hopelessness. Before leaving I said to her that with all her accomplishments and honors she had won, wouldn’t it be a shame that in the end the only race her children would remember was the one she dropped out of.
As we said goodbye she whispered, “I’m not going to drop out”. I told her to keep in touch and let me know. Making heartfelt connections with your doctor is a healthcare system that promotes healing.