Keshav's healthcare system thoughts (C.O.P.E.)

                                                                        2015 X+ gift

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last initiating spark/

for this systematic, process-oriented warmth...

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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).

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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

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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.

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5/9/2016 update: Click here for my potential contribution. note: my potential contribution above is outdated
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