Wednesday, 30 September 2015

Wasted. A review of this weeks 4corners.

What do you do when you wake up at 3am and your beloved heads off for a super early run? That is right watch something on iView. This week it was a Four Corners episode on money wasted with our Medicare and Private Health Insurance systems.

I have a number of thoughts on it, the first is "Derrrrr! Look at the shocked look on my face. We are wasting money on health?” OK, so now we have the childishness out of the way, here are some real thoughts.

Fee for service is a problem, it always has been it all ways will be. I remember my dentist explaining to me why he doesn't charge "per procedure" and how charging adequately for his time only meant he was being paid to educate his patients to keep their teeth healthy for life rather than relying on expensive procedures like root canals to keep his doors open.

Dentistry is one of the worst industries for creating work for themselves. Very low cost check ups or scale and cleans often lead to follow up visits for major work.  Some of this follow up is completely justified, but some of it is unnecessary or even the result of damage the dentist has done. Most dentist don’t spend the time during the initial visit teaching their patients how to clean and floss effectively and other ways they can keep their teeth healthy for life. If they did this using a fee for service model, they could not afford to keep their practices open.

The same can be said for surgery. When surgeons are only paid adequately for performing surgery they are going to recommend more complicated procedures more often than not. But it is not just about the money.

Surgeons go into their chosen field because they like surgery. It is a skill and an art form. Would you study fine art for 10 years to spend your days colouring-in? Or go to the Australian Institute of Sport just to be able to kick a soccer ball around with your 4 year old? The attraction is not just money, but the allure of being able to practise your art. And like other skill sets, use it or you lose it. Here is where it becomes a problem. When you actually need surgery, you want a skilled surgeon or you are less likely to have a good outcome. But this doesn’t justify throwing others under the unnecessary surgery bus just to keep the doctors skills up.

When all you have in your tool box is a hammer, everything looks like a nail. Medicine has 2 tools, drugs or surgery.

Chronic pain has never been caused by a pain medication deficiency and most of the time surgery is more than just unhelpful, it can cause more issues, more pain and less mobility. Modern medicine is fantastic for some things. This is the life saving stuff; treatment after serious accidents, organ transplants and antibiotics for life-threatening infections. This is their strong suit. What they don’t do well is getting you back to good health.

Barring antibiotics, there is not a single medication that is designed to treat the CAUSE of a disease, they are all aimed at treating symptoms. The same is the case for a lot of surgery.

Let’s take hip replacement surgery for example. You have a dodgy  right hip, as you age it gets worse. Your doctor sends you to an Orthopedic surgeon who says yep, it is bone on bone and worn out because you are getting old, let’s replace the joint with a pretty titanium one. But is it age that is the “cause”? I am pretty certain your left hip is exactly the same age, so that doesn’t add up. The worn out joint is only a symptom of an underlying imbalance, it is not the cause of your hip pain.

This is a problem that is far greater than what was covered in 4Corners. It is not isolated to orthopaedic and cardiology departments. Oncology is a huge one and obstetrics is enormous. Marsden Wagner wrote about how modern obstetric practices cost a shit load of money and do not positively impact mortality and morbidity rates for babies and definitely do negatively impact mortality and morbidity rates of mothers. The more money we spend, the more tests, the more interventions the worse the outcomes for babies and mums. This is not new, Pursuing The Birth Machine was written in 1994 yet we keep going down this path. 

The wasted money is only a small aspect of the fee for service model. It is costing lives. Every surgery has risks associated with it; this includes death and paralysis. Yet even complicated back surgeries are dismissed with the word “routine.”

What can YOU do?

If you want to live a healthy, pain-free life into old age? Eat real food in season, move your body in all the ways, observe circadian rhythms (light, dark, cold, hot), nurture great relationships, look after your gut flora and your nervous system. You cannot rely on doctors to fix a lifetime of shitty lifestyle choices with a pill or a procedure.

You can make decisions BEFORE you have a problem. When you are in chronic pain or a serious health crisis, a lot of the time all you can think of is what is the quickest way to get out of this place. You become hyper-rational about what options you have. So when a doctor says, this procedure has a 40% success rate, you are going to put yourself in that category because you want so desperately to stop being in pain or sick. You will down play risks and put more weight on benefits. It is just the way we are. Think about what your plan of action could be if you are faced with a health crisis. Once that is done, you might never have to think about it again, but it will be like a piece of health insurance for future you.

When offered any suggestions about your health, use BRAIN:
What are the Benefits?
What are the Risks?
What are the Alternatives?
What does my Intuition say?
What happens if I do Nothing?

Talk about the answers to these questions with someone you trust. Get some perspectives. But whatever you do, don’t feel that you need to follow the same path as everyone else.

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