'The Health Care System: Part 1'
CAERS SUBSTACK ARTICLE #57
‘The Health Care System: Part 1’
CAERS Substack Article #57
People sometimes lament that the Health Care System (HCS) is too focused on disease and it should, given its name, focus more on health. At one level that seems to make a lot of sense. On the other hand, maybe we need to look a little deeper.
Would it make sense for a skilled owner of a well-equipped autobody repair shop to stand by the roadside and wag their finger at drivers to encourage them to drive more safely to avoid an accident that would require their services? Maybe, but there will still be accidents that need such repair, so why not have the skilled owner use their skill and tools to do the repairs instead? There are likely cheaper and more effective ways to reduce (though never eliminate) automobile carnage than wasting the skills and complex tools of an autobody expert.
The same might hold true for the HCS. For example, many wise and talented people outside of the ‘traditional’ health care system promote exercise as being good for health and can guide people how to do so, and that is a very good thing. However, most if not all athletic activities have potential for injury and harm. Even with appropriate care and equipment, if enough people play a sport, sooner or later someone is going to get hurt; it is likely impossible to prevent all fractured bones associated with skiing.
If you develop back pain, even if it is from athletic activity, by all means see a physiotherapist, osteopath or chiropractor to get the treatment and preventive measures necessary to control it if at all possible. But if your tibia is sticking out through your shin at the bottom of the ski slope, you might want to consider getting an orthopedic surgeon involved. When I was in practice, my patients and I were much better off when I did things that utilized my years of specialized training. For example, it was better that I provided anaesthetics that facilitated the repair of broken tibias, rather than doing something I was not nearly so well trained for, such as hands- on treatment and education regarding back pain. Equally, we don’t expect physiotherapists, etc. to give anaesthetics, either. Usually my job was simply to reassure most patients that their back pain was not indicative of a serious underlying medical problem and therefore to see one of the health care professionals mentioned above for help.
The traditional HCS is filled with people who spent years learning to do very complicated and specialized activities, utilizing very expensive resources like hospital operating rooms and ventilators, to help when things go seriously wrong. And things will always go seriously wrong at some point, no matter how hard we try to reduce their incidence, and that is the forte of the traditional HCS. Unfortunately, we have expected the HCS to not just fix everything but prevent everything as well. Neither of these is realistic. When we expect too much, we can fall into the trap of believing that there is no limit as to how much money we can and should sink into the HCS. We can deceive ourselves into thinking that ‘health care’ always trumps everything else. But we cannot prevent all bad things from occurring: accidents happen, biological systems deteriorate, we all age and eventually die. In addition, lots of other things in our lives are important beyond just our health, so we must spend our finite resources, personnel and their talents, as well as time and money, wisely.
Have we expected too much from the traditional HCS during the pandemic? And have we spent our resources wisely? Did we focus too much on one virus and too little on everything else? And did some of our measures to mitigate harm from the virus contribute to deterioration of our overall health in the process?
These are questions worthy of considerable discussion going forward. When we do not use our HCS wisely and efficiently, we will likely find ourselves disappointed, and that will be the topic of my next article.
J. Barry Engelhardt MD (retired) MHSc (bioethics)
CAERS Health Intake Facilitator
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