European Observatory on Health Systems and Policies
Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society. An explicit health policy can achieve several things: it defines a vision for the future which in turn helps to establish targets and points of reference for the short and medium term. It outlines priorities and the expected roles of different groups; and it builds consensus and informs people.
So Who Put You in Charge
You’ll notice that the heading for this text isn’t phrased as a question, “Who Put You in Charge? ” but rather as a statement. That’s because there’s no question about it: you are in charge. If you doubt that for a minute, let me tell you one person’s story: I was on a weekend cruise, relaxing for once, sitting on the deck in the sun working at my computer (okay, only relaxing a little, but I was in the sun at least). A woman approached and asked if she could sit at my table and share my sunlight. “Please,” I said, offering her a chair.
“You’re just like my husband,” she laughed, nodding her head to indicate her husband sitting at another table in the shade a few yards away, “always working. I can’t believe you’re here, looking at this beautiful ocean, and neither of you can shut off your computers and just relax.” Sensing she wanted to talk, I closed the lid of my laptop and snuggled into my chair for a nice chat. What I didn’t expect was that I would still be working the way I usually do-listening to people’s health stories.
“I’m trying to get my husband to slow down because he’s been very sick.” “What has he been dealing with?” I asked. “Pancreatic cancer. Very advanced, usually deadly. But he’s out of the woods now, thank God. We had a tough battle, but it looks like he won.”
Listening to the background of his condition and treatment, I became fascinated when she spoke about how they had gone about getting treatment. “We just decided to fight the fight of our lives. We weren’t going to lie down and just watch him die. We used the Internet and books and friends and doctors to find out everything we could about the condition and what treatments were being used. We took charge of his condition [her words, not mine]. We found that there were only two doctors in the country that were doing the cutting edge surgery that we thought he needed, so we refinanced our house and picked up and went to Texas to get the treatment. And we never gave up. We had bad days-lots of them. But we saw this as a battle for which the only acceptable outcome was victory and I’ve just convinced that those two things-positive attitude and taking charge of our own care-are why my husband is sitting here today.”
“That’s amazing,” I said. And I meant it. What a wonderful, uplifting story. I could just see the love that woman had for her husband and the appreciation she had for the gift of having him with her today. But I couldn’t stop myself from thinking, “Why did it have to be that way? What about the people who didn’t know they had to take matters into their own hands, seek out the right doctors, find the newest treatment; that gave up on themselves and died without having a fighting chance? Wasn’t our system supposed to take care of them, too?”
As if reading my mind, the woman went on, “I know this is true because you’ll never believe it. One year after my husband was diagnosed, our minister found out he had the very same type of cancer. We talked to him about it, about what we had found out, how we’d fought for our lives, but he just didn’t want to hear it. You could see he had just given up. Six months later he died.” “I’m so sorry to hear that. That’s a tragedy,” I said. “I still wish I could get my husband off that darned computer,” she smiled.
The answer to who put you in charge is our health care system. Don’t doubt for a minute the first of Taylor’s Laws of Health that you’ll see throughout this book: you are on your own. You are on your own to make sure you don’t suddenly get a life threatening condition. You are on your own to make sure you don’t have a bad reaction to a medication. You are on your own to keep yourself safe when you are in the hospital. And you are certainly on your own when you need the care that will save your life. But saying you’re in charge and actually taking charge are two different things.
For some reason, when we enter the doctor’s exam room, years of maturity, responsibility, and knowledge just get washed away and there we are, in that little paper gown, sitting on that cold exam table, feeling about eight years old. Not just physically naked, but emotionally naked as well. Afraid to say what we want. Intimidated that we just don’t understand our own bodies. Embarrassed to talk about symptoms or admit to habits that are less than perfect. Our system was designed that way-to make us obedient patients who would listen to our doctors-but now that system has been turned on its head, putting your health, and your life, at risk.
The System Is Killing Us
Not only does the system do little to keep us from getting sick, in many instances it actually causes more problems than it fixes! Medical mistakes are a serious threat to your health and well-being. The total number of people who die every year from medical errors varies so widely and goes so unreported that I can’t really state an exact figure here. Take a look at some conservative estimates on medical mistakes:
Mistake Estimated Deaths Every Year
Adverse drug reactions 106,000
Medical errors 98,000
Bedsores and infections 203,000
Unnecessary procedures 37,000
Add to this an estimate of 8.9 million unnecessary hospitalisations every year and it’s enough to scare you into being healthy! In 1994, Dr Lucien Leape published a paper in the Journal of American Medicine titled “Error in Medicine” that took a good, hard look at the harm our system was doing to our health. Dr Leape compared the deaths from medical mistakes to the equivalent of three jumbo jets crashing every two days. At that error rate, I don’t think any of us would ever get on a plane again. Leape also acknowledged that because the data on medical errors are sparse and since we know that the vast majority goes unreported, his figures were probably very conservative. In fact, what Leape was saying is that a lot more people were dying than even his statistics, as troubling as they were, showed. Leape hoped this report would “fundamentally change the way [the medical community thinks] about errors and why they occur.” Sadly, over a decade later, no real changes have been made in our system, and people just keep dying. In fact, another report issued by the Institute of Medicine offered an even worse picture. In one part of their study, 1,047 patients admitted to a large teaching hospital were studied. Of those patients, 480, or 46 percent, had an adverse event- a situation where a bad decision was made. For 185 of those patients, the adverse event was serious, causing disability or death. Do the math on the number of patients in every hospital in the United States and the figure is astounding. How could it be that a system that’s supposed to save our lives instead kills more people each year than all other accidents combined? Are those hospitals literally more dangerous than war zones? To understand why these mistakes continue to happen, you have to understand how our medical system works.
Nobody’s Perfect, Right?
Our medical system operates on an infallibility model. It’s assumed that the doctors, nurses, technicians, and other people who provide your care will never make a mistake—will be infallible. “What’s so wrong with that?” you might ask. Well, for starters, you and I both know (and the system seems to demonstrate) that none of us is infallible. We all make mistakes. But having a system where perfection is presumed means that each person down the line assumes that what the person before them did was correct and so does nothing to double-check, take any steps to catch an error, or correct any errors that could have occurred, because, according to the system, no errors ever occur. This means that often errors get worse and worse and worse as they are compounded all down the line, eventually, in the worst cases, resulting in a patient’s death.
Even worse, there is such a stigma against reporting errors that almost all mistakes are swept under the carpet. This means they’re never examined to see how they could be prevented from happening again. It’s estimated that only 1.5 percent of all mistakes are ever reported, mostly by patients themselves! Doctors and nurses, living in fear of malpractice suits and disciplinary actions, have no training and no motivation to prevent and fix mistakes.
Doctors are suffering at the hands of our system as well. More and more medical students are being forced to turn away from what they love-treating patients-and turn to more lucrative specialities like plastic surgery, dermatology, and eye surgery.
A doctor whose daughter was in the same kindergarten class as my daughter told me of his struggle. I’m a family practice doctor-it’s what I like to do-but I’m going to have to give it up. I feel like I’ve tried everything but nothing’s working. First I took a job with a big medical practice as one of their staff physicians. But I was just asked to grind out as many appointments a day as possible-get ’em in, get ’em out, I used to say-and it just didn’t feel like I could give people the care I wanted to. So I decided to open my own practice.
I could see from the medical group that there sure wasn’t a lack of patients. But soon after I got started, I could see there was going to be a problem. I signed on with some health insurance plans and even some government plans. I agreed to take Medicare patients because I have a lot of experience with senior care. I started seeing patients and at first, it was great. I took my time, went over their history, ordered tests and screenings.
Then I started filing my claims. Oh my gosh. I admit it, the business side of being a doctor has never been my thing. I mean, I can do it, but I like concentrating on the patients. But anyway, the reimbursement rates were so low that I couldn’t even pay my office rent every month. One government plan paid me ten dollars for an office visit. These office visits were taking me around thirty minutes each. So I started doing what I was doing before, trying to move patients in and out as quickly as possible. But that’s just frustrating to both them and me. I know I need to be efficient, but I just don’t think I can give people the care I think they need under these circumstances. I’m going to start making mistakes and missing things and I just don’t want to practice like that.
That’s why it’s so important for you to be on top of your health and take charge of your care every step of the way. You are your own best advocate, and many times you are your only advocate. Even the most dedicated, talented doctors make mistakes and feel the push to move faster, do more. It’s your job, your responsibility; to do everything you can to help them do their job right to protect your life. But as you set out to take charge of your health, one of the challenges you face is how to sort through all of the information, the mixed messages, and the onslaught of marketing that is thrown at you about your health every single day.
