Public Need, Professional need ... What About Individual Need? Paging Dr. Rogers!

The humanistic movement has influenced our healthcare system in important ways over the past century, in North America. It has led to greater accessibility, equality, kindness and compassion in the way in which healthcare services are rendered to members of the public. Much of this has been achieved through community development initiatives that could only be implemented through socialized medicine, as is evident in Canada. Unfortunately, as is often true with socialist policies, frontline practice has resulted in a coercive consensus. Noone has sought to challenge everyday practice primarily because of the ethical superiority claimed by practitioners, that supposedly underlies healthcare practices today. Yet, many of the abuses carried out by patients and professionals in the healthcare industry (alluded to in earlier weblogs) interestingly stem from a lack of true person-centredness or "client-centredness". Some of these problems include the following:

[1] Maintenance of Confidentiality: Probably one of the biggest causes of ethical violation in the healthcare industry today; the causes are numerous from "multiple doctoring" to clinic and hospital procedures and lack of consistency in ethical practice between professionals in different sectors of the economy - healthcare, education, law/justice, etc.;

[2] Informed Consent & Decision-Making: The healthcare industry and its policies for good or for bad, start with the major premise that members of the public are not able to make important decisions about their own healthcare even though there is an outward show and "do-it-yourself" paraphernalia (such as forms, kits and other do-dats) that are supposed to indicate greater individual freedom. Once again, there are numerous examples of this. It begins with the government telling individual citizens who they should go to in order to receive a particular service through the power of professional colleges and boards of examiners. Members of the public are not aware that there are many other members of the community who may be equally skillful at treating a particular disorder and indeed has been trained to do so but for one reason or the other has not received a license to practice. All this is supposedly furthering their agenda of public protection from unethical practice by so-called "quacks".

The list continues... The unfortunate case where a family man who suffers a motor vehicle accident with minor soft tissue injuries, is thrown into a world of so-called accident specialists who apparantly know more about his welfare than he does! With his vehicle totalled and stuck in the backyard of an auto-body shop, he finds himself jobless with no money but simply promises of future re-imbursements and reams and reams of legal forms signing away basically his rights to everyone except his pet iguana. Over the following few months which can be stretched to over a year, this man is poked and prodded and subjected to a series of unnecessary procedures (including mental health) often at his own expense. If he survives this humiliating course of events which may include court battles and other forms of mediations, he comes out of this mess with a broken car, thousands of dollars in debt, medications that have destroyed his system, sometimes severely drug-dependent, family structure totally disorganized and with a list of disorders in his medical history (significant portion of which is iatrogenic or grossly exaggerated in order to obtain accident benefits from third parties).

[3] The use of unnecessary healthcare procedures/practices: The healthcare industry in the wild west is one of the most successful sectors in the economy. It is interesting to note that with the exception of a few other allied sectors such as pharmaceuticals, bioengineering and third-party/insurance services, the healthcare world is by-and-large supported in one form or the other by public funds. Yet, once again, individual members of the public such as the sick and the disabled play a relatively minor role in how goods and services in this industry is provided. This industry includes in broad terms other aspects of this economy such as training/education, research and development.

There is really no end to the degree of precaution that one can take in order to ensure safety and well-being and to prevent disorder or worsening of a current condition. Much of this is subject to one's own worries and uncertainties associated with one's own health condition and societal/cultural norms at any given time in history. The complex health promotion sector of this industry can be seen to utilize sophisticated marketing and advertising strategies to capitalize on this opportunity to sell healthcare goods and services. They will use fear tactics, celebrities, social embarassment, glossy literature and other techniques to sell healthcare goods and services in the name of public safety and well-being. If all else fails, then they are willing to push members of the public to engage in gambling activities for their own private enterprise and a yet misunderstood, public need. Unfortunately, all this may be totally unnecessary to an individual.

My grand uncle (a saintly man) for instance, who passed wind as easily as we blink or swallow, never to my knowledge visited a physician for his bowel functions thinking it to be quite normal to do so in public. Was this a health problem? Not for him! Not for us - his family! For Canadian society? Maybe. If it was left up to the health promoters, my lovable grand-uncle would have had to undergo extensive medical procedures...(Note: Disability is defined first by society and then later, if society has been successful, by the individual)

The travelling flim-flam, "elixir" salesman of the nineteenth century has now been replaced by so-called "ambulance chasers" and other para-medical professionals who literally "recruit" patients and usher them into a world of so-called managed care where the patient is often placed into a "sick" role where s/he is seen to need further healthcare goods and services that can cure them of their so-called illness or pain. I have seen cases where the purchase of an orthopaedic mattress was billed under psychotherapy by a rehabilitation centre! From sedatives to magnetic resonance imaging and CAT scan procedures, the literature is replete with examples of unnecessary healthcare goods and services provided by healthcare professionals in the name of public health and not individual health.

It has been said that when Pope John Paul was in his last days, he was advised by his medical caretakers to go to the hospital. He simply asked them about whether or not there was anything the hospital could do that the Vatican could not do. Their response to him was that there was nothing that the hospital could do although they would recommend it. The Pope decided to remain in his room during his last moments.

[4] Hidden costs of healthcare services: Perhaps the greatest cost that one can think of in healthcare terms, comes in the form of human life or should I say "death". While we have been debating over the vice and virtue of chocolates and coffee and the latest make-over techniques, free thinkers have been busy unearthing important information about costs due to healthcare services. According to recent researches carried out by Dr. Richard Besser at the Centre for Disease Control (CDC) and others elsewhere, economic costs for unnecessary medical events amount to approximately US$282 billion annually. Deaths due to medical interventions amount to over 783,000 annually. This places deaths due to iatrogenic factors as the biggest killer in the US only to be followed by cancer and heart disease (Canadian Stats are difficult to retrieve - cf. study by Karey Iron and her associates at the Institute for Clinical Evaluative Sciences, 2003). Detailed information about these and other costs can be retrieved from the following websites

http://www.lef.org/magazine/mag2004/mar2004_awsi_death_01.htm

http://www.niausa.org/research/

http://epe.lac-bac.gc.ca/100/201/300/cdn_medical_association/cmaj/vol-164/issue-5/pdf/pg680.pdf

http://archives.cnn.com/2000/HEALTH/06/01/antibiotic.overuse/index.html

[5] Health issues not addressed, lack of closure & follow-up:

[6] Diagnostic chaos:

[7] Increased adversarial relationships between patients and healthcare professionals:

[8] Conflict of interest: