I wrote this article in 2008 and still very relevant today! Will things ever change or will we have to wait for a total catastrophe.
Healthcare or ‘Sick-care’ system? It’s time for a new movement – Integrative Medicine
The health care system in Ireland has become a "sick care" system, addressing the disease and not the patient. Walking into most healthcare facilities in Ireland is, for the most part, not a pleasurable experience; this system is obviously and painfully in need of repair. Providing health is not a goal of our current system; managing disease is the name of the game.
It seems clear that if we continue down the path of healthcare delivery we currently practice through the HSE, even if it is practiced a bit more efficiently, we will have failed. The public services have already bankrupted the country and a revolution needs to happen in the department of health to abate our declining nation’s healthcare system. We cannot continue to do what we have been doing for most of the last century and expect a different result now, and furthermore what we are doing now is not sustainable. Healthcare technologies are more expensive, more people want access to them, and reimbursement mechanisms neither provide national coverage nor reward improved care or future planning. To say it bluntly - Our current system is run by private insurers, the pharmaceutical industry and hospitals trying to maximise profits.
We need a comprehensive system that looks for the most efficient and rational use of our resources, moving beyond disease management and beginning to focus on optimal health, wellness and prevention.
Public sector staff working on the font line are in my experience trying their best often with back end management unable to meet their needs - not because there are too few but because there are too many! Nobody in back management is taking responsibility and I don’t believe they are aware of their incapability and how bad they are at their jobs.
In all, the historical role of the doctor/consultant as comprehensive caregiver has markedly diminished. With the deterioration of doctor – patient relationships, the high reliance on expensive and invasive technology and the widespread perception that doctors today are more focused on disease than on healing and wellness has opened tremendous opportunities for providers of alternative therapies.
Nearly forty percent of Irish are now using some form of alternative medicine. Health care providers are confused and frustrated by these statistics. They are also frustrated by the pressures of the conventional healthcare service and its results. Sadly, conventional medicine, in its attempt to cut costs by limiting nurses, doctors and consultants’ time with patients has, in fact, sabotaged the effectiveness of doctor – patient interaction. Rather than utilising their diagnostic skills, doctors save time by relying on costly, impersonal technologies and pharmaceuticals that may be less revealing than holistic case histories and physical examinations. Alternative medicine takes these issues into account and hence the movement of Irish people realising the benefits of these therapies such as acupuncture, herbalism, psychotherapy, yoga and physical exercise.
I believe that the healthcare system must be reformed to restore the primary function of caring and the practitioner – patient relationship, to promote health and healing as well as treatment of disease, and to take account of the deficiency of science and technology alone to shape the ideal practice of medicine.
The new design must also incorporate compassion, promote the active engagement of patients in their care, and be open to what are now termed ‘complementary’ and ‘alternative’ approaches to improve health and well being.
What we currently have is a reimbursement-driven disease management system that provides care that has little focus on outcomes and in many cases has little scientific evidence of effectiveness. No wonder we spend at least twice as much as most other developed nations on healthcare yet rank near the bottom on every benchmark of health.
So what steps can we take now?
First, we must set out clear guidelines to understand the purpose of the healthcare system we are trying to create and how conventional and alternative medicine can fit into an integrative redesigned healthcare system. The health services must be measured correctly and increase the health of the population that receives the services.
Second, and most importantly the needs of the patient must come first, and the patient must be in control of their healthcare based on their needs and values.
Integrative medicine will be a critical component of any healthcare system that offers hope for true reform. The services will need to be delivered by a healthcare team that includes a variety of licensed healthcare practitioners to maximise health, wellness, and healing. Integrative medicine is not a radical movement but it can produce major change.
Its point is to position medicine so it continues to build upon its fundamental platform of science but to reposition itself to create a health system which more broadly focuses on the well being of our patients as well as its practitioners. The integrative medical approach emphasising a variety of therapies will also show substantial improvement to clinical outcomes and cost analysis compared with conventional medicine alone.
To integrate this approach we must:
1) Refocus on the patient as a whole and the incomparability of meaningful practitioner-patient relationships. More and more of the benefits of our health system will require changes in patient behaviour, i.e. modifying lifestyle, diet and emotional issues as well as taking therapeutics correctly. Such changes will require far more meaningful practitioner-patient relationships.
2) Involve the patient as an active partner in his/her care, with an emphasis on patient education concerning how they can best improve their health.
3) Be open to understanding the benefits and limitations of conventional medicine and the realisation that science alone will not effectively deal with all the complex needs of our patients. Many patients, particularly, those with chronic or life threatening conditions want access to complementary and alternative approaches. Our current health system must rationally address these needs.
4) Advocate for sound clinical research to test the efficacy of complementary and alternative therapies and strategies.
Fundamentally, Integrative Medicine is meant to provide the best possible medicine/healthcare, for both doctor and patient, and the success of the movement will be signalled by dropping the adjective!
I simply want to live a healthy and fulfilled life.