Dr. Jeff Kane: Rethinking healthcare
Almost a half-century ago, as chief physician in a busy county emergency department, I began to see patterns in illness and injury. While some conditions seemed to simply happen, it was obvious that many patients’ troubles stemmed from their situations and choices. You know what I’m talking about: the long-term effects of poverty, poor nutrition, ignorance, alcohol, stress and so on.
I’m far from the only one to make this observation. These indirect causes are now called “socioeconomic determinants of illness.” For example, we’ve known for decades that life expectancy is linked to zip code. In places lacking clean air and water, genuine food stores, public transportation, healthcare facilities, or even hope, people naturally get sicker more often. Healthcare responds, “Sorry about all that, but that’s not our department.”
As things are now, we docs are expected to treat only the immediate agent. And we’re reasonably effective at that. We can widen the coronary artery that was narrowed by dietary sludge. We can prescribe antibiotics for that kid, raised with poor nutrition and neglect, who got pneumonia. But what caused the arterial sludge and the kid’s diminished immunity? If we don’t attend to these factors, repeat visits are a certainty.
It seemed to me that applying virtual bandaids to patients and then returning them to the same conditions that delivered them in the first place was useful immediately, but in the long run absurd. I dreamed I was cranking an expensive, high-tech merry-go-round. Or worse: my well-meaning intervention was actually helping perpetuate sick-making behavior and circumstances.
Medicine practiced this way is like eternally patching a leaky dam with never a thought to rebuilding it. I don’t suggest we stop patching; I myself have benefited from patching. But what would healthcare be like if people saw their illness and its treatment in the context of their whole life?
This task shouldn’t fall to my colleagues. Doctors have more than enough to do. Tracing illness to its primary source should be up to our society: parents, teachers, therapists, nutritionists, cops, social workers and especially friends. If we truly intend a style of healthcare that’s more effective, more meaningful, and cheaper than our present one, we’ll need to recruit the whole village.
Jeff Kane is a physician and writer in Nevada City.
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