2015 X+ gift
*
for
this systematic, process-oriented warmth...
* * * * * * * * * *
Background:
Clear, General Values/Priorities To Focus Upstream
Rated
for promoters (e.g. COPE, ITUP) of a healthier and
sustainable world
By
Keshav Boddula (a.k.a. Kiki, Kiki Bo)
From
this position-time,
here's
some thoughts that may be helpful to Community Outreach Prevention
Education (COPE) or Insuring The Uninsured Project (ITUP),
including ways
I believe that I personally could more directly help in their
implementations
as appropriate and with a religious-like, self-determined block
manifest in not paying income taxes to support the USA military's
current bad, non-mutual priorities with the rest of the world.
A
proposed solution at this level of scoping and fixing
in which Atul
Gawande analagously describes
when he speaks of the problematic health system as putting together
the best car parts to build a car that would not work, is to have all
the car designers coordinate their build to a single system (likely
under an umbrella of a common goal). This system should be inclusive
to all in a similar, however potentially better, way
as nearly anybody should be able to good, lower-priced, and
environmentally sustainable
model that still performs the basic needed functions toward the
patient's best, sustained health (including allowing a realization
that a car is not even usually needed to begin with (except for an
emergency-type of situation)). I agree that creating innovative
positions like care coordinator, health coach, and motivational
interviewer, help in shifting
priorities in a good, healthy direction toward “root”,
“upstream”, or preventable levels of “important” health
problems of the population,
including career choice priorities of health-field oriented
individuals in a welcomed way especially given that their choice
toward the field was or is for a genuine caring of others' health
perhaps aligned with a (socio-)cultural attitude shift that “our/the
stronger care for the weaker”...
Given
COPE or ITUP has sufficient power to promote healthy, sustainable
change
in relation to insuring the uninsured in
a generally powerful yet imbalanced setup,
then focus should be on more sustainable, longer-term, broader
actions that are toward problems more upstream (e.g. the “P” &
“E” in COPE) and less of patching downstream (e.g. “promoting
an interest in the safety net” by focusing energy on solutions to
more downstream solutions) like focusing efforts on acute, emergency
medicine. This shift in priorities should lessen downstream
problems, which I experientally understood from post-ER-discharge
calling as a C.C.E. at St. Francis Medical Center, and further
clarified and reinforced in other activities such as taking the
University of Minnesota's Preventing
Chronic Pain: A Human Systems Approach course, (with a specially
selected sample multiple choice question from this course with
the correct answer
below:)
Q:
Transformative care requires health care providers shift their
paradigms associated with care of patients. Which paradigm below is
NOT part of a transformative
care model?
(a)
Empowering and motivating patients with strong social support
(b)
Relying on strong partnerships for long-term sustainable change
(c)
Assuming that people are multi-dimensional with a need to understand
and change all risk and protective factors in each realm of life.
(d)
Focusing primarily on curing the illness using the most current
biomedical treatment
(e)
Focusing on education, training self-responsibility, and self-care
*note:
complex, but although electronic health records and processes may
have many benefits, consider not blocking the advantageous paradigms
in (a) and (b) above, as well as the komplex value of an individual
learning on their own. And
(as this resonates to the reader,) I believe the complex problem
sometimes when trying to discourage this pathological thinking that,
“there's not much negative consequence for my (potentially)
unhealthy actions because there will be an invested safety net to
catch me” may negatively deter efforts toward a patient's
self-responsibility for their best health as well as potential health
workers' long-term-financial-security invested path to practice (see
in 'Ideas For Doctors' section below,
including ideas
to discourage opioid abuse).
* * * * *
Ideas
For Patients
*Rated
for people in positions of political responsibility or power:
Epidemiologically
setting things up to make it easier for people
to habitually make good, healthy, balanced, sustainable choices (e.g.
transform
bad unhealthy, imbalanced, unsustainable food desserts, liquor
stores,
unsustainable industrial priorities, low-priced meat, fatty food,
tobacco, and oil-derived products, car/oil-friendly streets,
“badvertisements”, imbalanced production and consumption,
and
other 'drugs' (like humancentric banks) to
good, healthy, balanced, sustainable urban farms (“If
kids grow kale, kids eat kale.” - Ron
Finley), shared, cooperative housing, sustainable
development priorities, high-priced meat, fatty food, tobacco, and
oil-derived products, healthy-human-friendly streets,
“goodvertisements”,
balanced, environmentclusive, more realistic costs with life-cycle
assessments and healthy activities (like seed banks) as needed). And
to the extent things are not setup as good, a self-managing patient
can maybe start by truthfully asking themselves during meals, “?What
did I do to deserve this food? and how will I make the best use of
this energy/nourishment?” And some examples here:
-“Shop
with Your Doc” type of opportunity
where there's a clinic/tent setup at a grocery store (with PCPs,
dietitians, nutritionists, food educators, health coaches) to
promote exercise and healthy eating
(like yoga, tai chi, cooking classes, farmers' markets, Supplemental
Nutrition Assistance Program/CalFresh,
hypnosis (especially with a former badvertiser's voice that makes
healthy choices sound irresistible), and even prescriptions for good
foods!)
-
The
non-obligatory
opportunity
to live more healthy and sustainably in a sustainable
eco-village-type of setup
that does not regard common considerations of legality in
property/ownership especially with an intent to first help
heal our planet's unfertile
grounds/soils
that are actually liveable/have potential to sustain life but not
necessarily prime real-estate types of areas like Beverly Hills or
uninhabitable-to-life areas ?like Death Valley. The opportunity can
then be scalable for
anybody,
but especially targeted to people without shelter, with mental
problems, or without a job that are willing
and able
(including "losers" in a failing "system" or
means of existence.) note:
potential
future collaboration with the group Health
Leads (Bay Area)
*Rated
for people in positions of power and responsibility:
Provide
open-access/open-source media information (especially
given the high usage of smart phones/connected devices) backed by
responsible, authoritative, accurate, reliable, “P” & “E”
aligned interests such as WHO, HHS, OSHPD,
Medicare/Medicaid, Covered CA in collaboration with less directly,
albeit importantly related health/environment organizations like DOI,
DOE, and EPA. Also, include a reverse disclaimer (“reverse” in
relation to the currently common disclaimer protecting legal
interests) to protect against important
considerations revealed in the *note
above. Additionally,
rated
for people who are good at promoting in person (e.g. “promotoras”)
hand out pamphlets with
good, appropriate information to live healthy. Either digital
or paper media would contain information and suggestions to protect
them from illness by making healthy choices and especially being
aware of unnecessary, unhealthy - although usually “tasty” -
solicitations (e.g. good, healthy alternatives to unnecessary things
like GNC, imbalanced energy intensive gyms, etc.)
*Rated
for highly-qualified individuals (perhaps as a team) such as
healthcare workers, public health workers/epidemiologists,
psychologists/sociologists, architects/civil engineers, and interior
design consultants):
Implement
waiting room health activities
strategically planned and placed in different areas and maybe even
personalized (therapeutic-quiet area, live or televised health talks,
games, interactions (e.g. personal
toolkit to prevent chronic pain), lessons, library, posture
chart, etc.)
*Rated
for same highly-qualified individuals as above: Build
~ or better yet retrofit ~ a sufficient-tech, basic, naturalpathic
health and wellness solutions resource center & clinic note:
potential prototype example from the Jindal
Naturecure Institute
*Rated
for I.T. specialists, software/ap-developers collaborating with
health educators, psychologists, nutritionists, environmentalists and
others that value the good of the whole over the (hopefully-past but
potentially-future) self-serving interests of an individual's
unhealthy ego or desires:
Create a learning tree
contingency type of ap
(similar to a computer program troubleshooter) where an individual
can learn optimally healthy choices, (e.g. if you choose this: it is
good because, and it is bad because... a more specific example is
basically like this: eating healthy, nutritious food rather than junk
food because... but then... rawer food is better for preventing
cavities than pureed food... Some other examples of “good” values
include shopping locally, slowly, and informatively until good habits
form. This would be especially
for people whose (good) habits are formed with the help of their IT
devices. note:
potential collaboration or prototype in GreenApes
* * * * *
Ideas
For Doctors
~
"It is difficult to get a man to understand something when his
salary depends upon his not understanding it." - Upton Sinclair
~
*Avoid
fragmented, non-collaborative care in preference for teamwork
with a comprehensive
scope that recognizes
(potentially) relevant aspects of the
“whole patient's life” including the environmental setup that
should be able to sustain health in an environmentally sustainable
way (i.e. meeting the needs of the
present without compromising the ability of future generations to
meet their own needs). Also, educational/outreach efforts should
focus toward
this model of doctor-patient relationship that see medical doctors
as, “experts on the population, but [patients are the experts of
themselves], and together can make a better decision than just the
doctor alone.” - Talithia
Williams
*Overcome
these (hopefully past) problematic paradigms such
as:
-Incentives for increased
self-value or money (usually from best grades to most profit with an
important effect being the confidence or self-worth of the student or
doctor and not necessarily the health of others or patients, all
respectively) often contributes to a less optimal biomedical approach
to health and illness (e.g. holistically
avoidable, unnecessary surgeries)
-Primary
or heavy reliance on traditional biomedical approach (especially in
regard to chronic illness) that sees diseases/illness as not caused
by the patient, and therefore the patient is not responsible or
does/did not have the ability to change or prevent toward good
health. (“...25
cents of every health care dollar spent on the treatment of diseases
or disabilities that result from potentially changeable behavior.”)
*I
believe the powerful knowledge or energy from a
learning-while-working,
apprenticeship-type of experience**
could be similar to the traditional, (although
“pathological” long-term-financial-security invested path to
practice)
pre-health professional, primarily academic study path especially
when the more self-empowering, Socratic learning method is used to
parallel their future work to empower their patients as opposed to
the traditional dependence of the future-doctor student to get an “A”
from the teacher, educational system, or belief in
advancement/reward, combined with a self-expectation that they just
should
do the work like they're told, which later tends to lend itself to
the now-doctor to have similar expectations projected on their
patient to also do like they did (and the medical system they're now
a part of) when striving for successful health, which may not be
realistic for many patients.
**This
apprenticeship path would be legitimized
more common-sensically to legally
(remembering the most
demanding-of-competent-to-care-for-what-is-“needed” patient, and
then ensuring that specific
treatment strategies, diagnostic strategies, procedures, policies are
followed in a consistent (in relation to the specific
situations/conditions) way) with competency verifications to becoming
a healthfield contributor in caring for others' health without
compromising effectiveness (or perhaps other “needed” standards
of measurement) given the integrity to match. (note: I understand
"needed" specially in this context in relation to how
people believe their tax money should be spent expressed in
Medicare/Medicaid types of spending (which is changeable, but
generally reasonable, "basic" services))
note:
“pathological” because it seems to exclude or compete against
another path ~ a path that does not psychologically exclude those
young people who truly do not know what their long-term goals are
(but (have been made to) believe they should
have one (especially to tell other people about or to feel better
about themselves)), smartly do not want to invest so much time,
effort, or money (they don't have) upfront with this uncertainty, and
may be very good contributors in the healthfield if it weren't for
the inundating prevalence of the current academic-oriented
competitive proving ground.
*Use a broadened definition or understanding of 'drug' in relation to 'the body' from the commonly-used humancentric meaning to a forward-thinking environmentclusive meaning. Usually the support of (current) normative economic activities to value greater efficiency, increasing profits/G.D.P. is without regard to the toxic side-effect costs to our environment/Nature and its sustainability for future generations to be able to meet their own needs.
*Guidelines
for use of controlled substances such as opioids with patients
with chronic pain include to: Sign
an agreement with patients regarding goals, expectations,
consequences, benefits, and risks and discontinue use if agreement is
broken or goals not achieved; Use opioids only as an adjunct
treatment for intractable pain, in coordination with a comprehensive
care program; Review state pharmacy on-line prescription registry to
ensure that only one prescriber and one pharmacy is providing the
medications (unless easily and smartly coordinated on-line for
common-sense discrepancies like the patient is moving for example, in
my opinion) ; Make sure all controlled substance medications are
stored in a locked cabinet (copied from preventing chronic pain
course).... However, to the extent a shift in perception of
the meaning and implications of the pain stimulus occurred maybe with
a more holistic approach to health (like with stronger social
supports, more pcps or the implementation of care coordinators),
there wouldn't be such unhealthy demand for opioids and subsequent
strict guidelines to have to deter abuse to begin with.
*
5/12/2018 updates:
(1) Emergency Medicine and Research Medicine should cross-examine each other more for the better-best balances (e.g. putting them in the same (dining) room, to get to know each other, etc. like academic inter-disciplinary “cross-pollination” spaces designing of a college campus)
(2) disregard my potential contributions here
