Redefining the Health Care Glossary: what is #realprimarycare?

2018-11-25T07:02:45+00:00
Health

Common misconception:  Absence of illness or injury

A little clarity:  The terms “health” and “wellness” describe a state of being in balance, indicating “wholeness.”  The idea of “health” should not be perceived as the absence of anything at all, but rather of being complete, missing nothing.

Health care

Common misconception:  That it has anything to do with health or anything to do with care.  This is, in my opinion, one of the most bastardized terms in modern culture.  In combination, these two words have become a phrase with such twisted meaning that I wish it could be done away with completely, but it is here to stay.

A little clarity:  Nowadays when we say “health care” what we are typically referring to is the delivery system of medical/surgical/pharmaceutical goods and services.

Health insurance

Common misconception:  Full-scale third-party payment platform for all of ‘health care’ which is usually obtained via employers or the government.  [NOTE: With the first party being the consumer/patient and the second party being the provider/practitioner, third parties do not participate at all in the encounter of service delivery.]

A little clarity:  Insurance as an industry was developed to decrease risk of harm, and in most formats (i.e., automobile, home, property, life, etc.) is bought and sold on the free market on an individual basis so as to suit the specific needs of the individual beneficiary.  Generally, the use of insurance is relegated to high-severity, low-frequency events such as accidents, fires, or burglary.  It was not originally intended for daily use.  Clearly, the unexpected can happen in the realm of health, and it is critical to have health insurance for this reason.  But the widespread overuse of insurance for routine, elective needs in health and medicine has caused costs to skyrocket to the point of unsustainability.

The Health Care System

Common misconception: We have come to understand that anything to do with providing “health care” (that is, medical goods and services) should be paid for through health insurance.  Together, the misconceptions of “health care” (medical/surgical/pharmaceutical goods and service delivery) and “health insurance” (full-scale third-party payment platform for all of ‘health care’) have led to a deeper and broader misconception that anyone without health insurance is at imminent risk of illness, injury or death.

A little clarity:  When “health” is viewed as threatened by disease, and when “health care” is treated as measures of treating or avoiding disease, “health insurance” is seen as necessary to eradicate disease as a means of reducing risks to health.  These vast misconceptions in aggregate have fueled the current state of our broken Health Care System.  At this point in history, the only way to reform health care is to understand the current state of “disease.”

Disease

Common misconception:  Anything that deviates from “perfect health.”  Therefore, to achieve health, disease must be eliminated.

A little clarity:  Having awareness about the history of global epidemiology helps to shed light on how disease is commonly understood and why it is time for a shift.  150-200 years ago, humans generally died well before the age of 70, mostly from infection or malnutrition.  Massive efforts abounded over the decades and centuries that permit us to prevent (sanitation, vaccines) and eliminate (antibiotics) infection as well as “end hunger” (avoid starvation).  Turns out there are side effects both to these efforts and to the simple fact of living longer.  These side effects are what we are now experiencing in the form of chronic illness which, thanks to complex pressures from within the medical delivery industry, gets pigeonholed into countless boxes known as “codable diagnoses” that get individually targeted and treated, rather than viewed as a general state of impaired health, or basically a lack of wholeness.

Turns out chronic illness doesn’t disappear with pills or top-down policy changes.  Frankly, it doesn’t disappear at all, that’s what makes it chronic.  To pursue health does not take pages of checklists reviewed by doctors, it does not take closetfuls of pills, and it does not even take eradication of disease.  It takes education and personal initiative.

Primary Care

Common misconception:  This is the hub of all health care (medical/surgical/pharmaceutical goods and services) delivery and therefore is inexorably tied to all of it.  Prevailing perceptions regarding Primary Care include “I can’t access any medical care without a primary doctor”, and “everyone needs a PCP”.

A little clarity:  As the “health care” (goods and services) and “health insurance” (payment platform) began to roll together in the 1990s-2000s in the form of Health Maintenance Organizations (HMOs), the role of primary care physicians/providers (PCPs) shifted into that of “gatekeepers,” such that all delivery of goods and services as paid for by the HMO requires authorization by a PCP.  Large, single-entity HMOs largely dissolved in the late 2000s, but have been creeping back into influence via less-obvious capitated health plans with “network PCPs.”  As a result, it is still confusing to tease apart the loyalties and incentives that influence decisions made by a PCP… even confusing for the PCP himself or herself.  The bottom line is that the classic visage of the Norman Rockwell personal or family doctor has all but faded away into assembly-line style high-volume clinics, urgent care facilities, and even telemedicine, not because they are most successful at treating or avoiding disease, but because they are most measurably cost-effective.  Meanwhile patients who have chronic health issues depend on a relationship with a medical professional who can follow the storyline of their care and guide them thru decisions without conflict of interest or questionable incentives.  Otherwise, each and every patient should learn to see himself or herself as his or her own Primary Care Provider, or PCP.  This is what we will be referring to from this point forward as

#realprimarycare

More to come.  Stay tuned.