A New Healthcare System
How To Create and demonstrate a new version of the healthcare system?
Based on the values of:
- First do no harm
- Informed consent
- Evidence influenced medicine
- The Coach Approach
- Holistic Medicine, emphasising nutrition, lifestyle and prevention
Over 2020 and 2021 I have seen the dramatic flaws in the health care system. These problems are not new but have been exposed by the pressures created by the responses to the Covid 19 Pandemic. With the problems so dramatically demonstrated, it has been far easier to see the solutions, or at least one version of a better system.
At the core of the problem is the influence of the pharmaceutical industry. This cartel is not in itself evil. It’s motivation just needs to be understood. The pharmaceutical companies have one clear objective. This is to return a profit to their shareholders. They have large and widespread influence, expressed in their control of university curriculum, influence over what and how trials are published. Today’s medicine is pharmaceutical medicine. We have a reductionist model where each doctor is asking herself “what medication will I prescribe at the end of this consultation”.
This is not the solution. This is a solution. We will need many options, from which we can chose aspects to create a solution that is fit for purpose.
I will offer 30 minutes as the minimum appointment time. This will create space for listening, hearing, expression, sharing and discussion. This will allow time to consider options other than just those written on a prescription pad.
- The hui method
Time for relationships to build. Time for the client to express who they are and what matters to them but also time for the health professional to express who they are.
The answer is 90% of the time in the history. Comprehensive and careful history taking must lead to better diagnoses.
The determinants of Health.
If the doctor has not asked “Why”, 7 times he has not considered the cause of the cause. The up-stream determinants are always essential to understand. Without addressing these we are treating the symptoms of illness and never the cause.
Meaningful diagnoses, rather than labels to make communication between doctors easier. The diagnosis needs to reflect the cause. Diagnoses like “Inflammation”, Insulin resistance” and “Mitochondrial dysfunction” will direct the health professional to more useful solutions.
More tools in the toolbox
We can no longer be mainstream doctors, integrative doctors, lifestyle medicine doctors, naturopaths and herbalists. We need to understand a broader range of options. The toolbox needs to be overflowing with options.
- The coach approach
The paternalistic attitude of the doctor who knows best and prescriptions that are imparted, even bullied, must stop. The client is the expert in their own health. Treatments will reflect this shared knowledge. Readiness to change/adopt, must be central to prescription.
- Follow up
Change is a process. Support needs to extend beyond the payment at reception on the way out.
We have seen evidence being ignored and suppressed. We need the courage to change practice and even say we have been wrong when the evidence informs us so. Evidence based medicine only works if we change our practice when the evidence informs us so.
Often the Doctor is not the best therapist. The bigger the team the more the option. I think health coaches need to be in every team as behavioural change requires support. The team needs to collaborate within the organisation and outside.
Apps, monitors, bio feedback. This gives the power to the clients and data is king.
Video and phone consults allow reach and options. Avoiding travel creates efficiencies and reduces emissions.
Our clinic will reflect the principles of Te Whare Tapa Wha. The individual and the whanau cannot flourish by hoarding resources. The clinic will enhance the environment and be self-sustaining for energy and water. We will utilise electric vehicles and be as self-sustaining for food water and energy as possible.
If the health professional is stressed, they can not give their best to their clients. Doctors need to create their own health. They need time to study and learn.
The new Health Authority and the Māori Health Authority creates an opportunity for innovation in funding and delivery. Māori Trust, Insurance companies and Employers offer different funding options.
Doctors need to demonstrate values, including integrity and courage to advocate for the needs of our clients.
Glen Davies 9/5/202