Clinical care market vs. demand

Coming to me with a question, an individual – patient or not – has an expectation and a need. The expectation is that – whatever I am about to do – I shouldn’t take this person by surprise. People already know what is wrong, know why it is wrong and already did something to make it better. When they come to me, they do so because confession makes them feel good! It’s not that much the information they need, as it is the fact that they need to know they did something about it. The last thing I am expected to do is make that person feel guilty, uninformed, misinformed or far from the truth that he or she perceives. The patient comes to me because, at this point in time, it HURTS. Whatever he/she found best to do in the past now has consequences that interfere with their quality of life or the quality of living of somebody else about whom they care deeply. I try not to mistake one’s need for life quality with one’s need to live. Some individuals do not have a clear sense of the “need to live”. In fact, they would flat out tell you: “listen, everyone has to die of something!”. This frightens me every time I hear it. I cannot understand how or why one would ever come in the state of mind that formulates this sentence. Over time I learned some sense about it though: it could be either a passive or an aggressive attitude. That is either their way of coping with the situation they are in or is their way of telling you: “don’t mess around with me and don’t tell me what my priorities are!”. Life is all about the quality perceived by that particular individual and this is precisely why that individual comes to me: because he/she cannot achieve the life quality they needed without at least talking about the respective ongoing issue. With this in mind, I have to be prepared to understand quickly and provide them with comfort and relief immediately otherwise I will not see them again. Of course, it is ok if I do not see them again – that is not what I am concerned about. My concern is that I might happen to be the last line of defense and if I fail that cause is lost. Any failure in my understanding or action might also prevent that person from ever reaching out for help again or might delay them doing so again for a long period of time in which significant life or quality of life may be lost.

I take such failure very personally. I know I shouldn’t, but I do! My interaction with an individual coming to me with a question is not a 10-15min answer, but a two-way communication lasting weeks, months, years or – in a few cases – a lifetime. That is because the answer to any health-related question is never simple. Everyone knows that the best solution for fixing a problem is removing the cause. Well, I cannot identify and remove the cause by giving a one-sentence answer, neither by posing an intellectual look while providing a 15min monologue. It takes time. I cannot do this having in mind performance metrics. The pride of a higher number of patients helped per hour is a form of genocide. …That’s my opinion. Many may think I’m crazy. Maybe I am, but that is the way I feel about cramming as many patients as possible into a working day. That is NOT “mastery” or “productivity”. That is genocide. The word “genocide” strikes because we are used to a brief window of time between the genocide-causing action and the mass-kill. If we extrapolate the same cause and effect on a scale that enables a longer time window for the occurrence of the same effect, then it is easier to see. The discussion can be vast. I will reopen it later in another blog.

heart-sthetoHealth is very much like money: if you do not know how to go about it to make it last longer, you are going to run out of it. Interestingly, this idea is far from novel. People have debated it in both philosophy and science fiction movies. However, if the interest behind working toward making the dollars last longer is desire- and comfort-pleasing, the interest behind living a longer and healthier life is in fact related to being around a few very important individuals for a longer time. Health is the key ingredient in fulfilling love and offering those we care deeply about a longer and better life. But, in order to make somebody hear me and intentionally act to improve their own health, I must first understand what does that patient live for. Anything outside of this key information is a waste of time and a generator of an incredible load of frustration on both sides.

Am I saying that every clinical care provider should be a psychologist first? I guess, in a way, I am saying that… This came as a surprise to me as much as it may come to you. But there is no surprise that anyone for whom you attempt to make a difference you should be able to reach on a level which he or she will be able to open, willingly partake in the exchange, and apply what I say in their own life. Let me make it clearer: I get to meet a patient or a caregiver in a moment that is about to shift someone’s living toward a different path. Whether that means eating less chocolate, drinking less alcohol, or quitting smoking – or, even worse, remembering to take an irritating action regularly, something like taking a pill or going to the gym. Well, if you intend to inspire anyone to do anything close to the above, then you are the messenger, the trigger that will detour one’s life for a considerable length of time, eventually forever. If you understand that “one cannot step twice in the same river”, then you understand that in such a moment you will indeed change one’s life forever! How come? It’s all about the TIME. The moment in time will never be the same again. THE MOMENT is key and your ability is the ONLY reason that will detour one from path A to path B. That “ability” is the synergistic mix of education, experience and wholehearted intent under the oath you once took to help all humans in need.

desire vs avoidSo, guess what? No human being on Earth will take such action-for-life-detour willingly if they do not trust you, if they do not feel CONNECTED with you. This is not a marketing process. Marketing is far easier. If you convince someone to buy something from you for one single time, their will to take that risk of wasting time & money and buying something from you ONCE is more probable than taking a medicine. Why? Because the only risk perceived in buying an item once is wasting “X” amount of money. Taking a health changing action, however, limits freedom. It is the total opposite of buying an item. Buying the item gives you euphoria, something along the lines of “I could and I did, what the heck??”. The process gives you the “taste of power”. The decision-power feeling gives humans pleasure, so they are likely to want to try something new or do something different. This is FANTASTIC for personal growth, science & discovery, for art or space exploration! But this is TERRIBLE, HORRIBLE, UNFIXABLE for proper healthcare implementation, damn it!

Try to think of suggesting someone any change that will give zero pleasure on a short term and will limit their freedom of choice while providing a benefit they neither understand, nor foresee. Would that work? It may, but that depends of the “perception of the consequence that could limit freedom”. In simple words: “what’s the worse could happen and why should I care?”. The ability to identify and convey a solution means pure-blank-NOTHING without identifying that particular perception of the consequence that could limit freedom for a respective individual. For example: all smokers know that smoking is bad for their health. They know it will lead to cardiovascular disease, cancer or death. However, they do not perceive any of these as consequences that could limit their freedom and they won’t stop. Interestingly, the birth of a grandchild and the desire to live long enough to protect that child can suddenly change one’s entire attitude. Not getting to reach the most important place for them, or missing something they always hoped for, such as sky-diving, are incentives for which humans will move mountains. They will rather make the change to sky-dive once, than living 10 more years. Many times that “something” or “someone” is a clue deeply buried and finding it takes a long time, a time that isn’t paid by anyone’s health insurance. Perhaps that’s why we fail at it. board-yes vs no

The healthcare system does not motivate clinicians to put in enough time dedicated to understand the real deep values of the patient. Not the case, but THE PATIENT. Not the past medical history, but someone’s LIFE behind it. Not the chief complaint, but the CRY FOR HELP. The immense void of the individuals seeking to be heard. A medication prescribed is not a medication dispensed and a medication dispensed is not even close a medication taken. Not more than a third of the medication prescribed is taken and only 1 in 10 that is taken is taken correctly, meaning on-time and in the appropriate context of food, sleep, other habits etc. This happens primarily because we failed to identify the perception of the consequence that could limit freedom.

The patient cried and we did neither hear nor understand why…

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Dr. Alice

I teach people how drugs work, when they are needed, and why. My expertise as a pharmacist and researcher allows me to determine whether taking or not taking a drug will pose any risk given all current circumstances that apply at this moment. Many times we don't know unless we try, but other many times walking the extra mile pays off giving in return more wonderful moments and more to give to others.

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