Who is watching out for us (and our health)?

Who should we trust to help us with our health? Our doctors? Our governments? Ourselves? Our health is our responsibility but we have had no choice but to rely on others to help. It’s just too complex, too expensive, too confusing. By necessity, politics will pose this question again and again until we find a way to answer it consistently. Until we do, there are 3 conflicting demands on us: (1) the heavy but diminishing weight of what I call “traditional healthcare” where physicians, hospitals, insurance companies, and government agencies command our attention as they appear to look out for our best interests, (2) a fragmented, often fickle, churn of commercial products and services intended to influence the way we make important health decisions (for the sake of simplicity, let’s call this “consumer healthcare”), and (3) a growing but consistent pressure for us to take better, more cost-effective care of ourselves and our families (I think of it as “empowered healthcare”).

With the never-ending confusing changes in the broader healthcare world, we must all ask ourselves a few important questions that no trusted health helper can answer:

Who really is watching out for me and my family?

How can I benefit from their help without feeling like I’ve lost control?

For what part of my health should I maintain direct control?

What am I missing? Who could help but hasn’t?

First things first. Let’s map out who is watching out for us, regardless of whether we asked for help. There are a lot of trusted health helpers to discuss…which is the point actually…so in this rant/blog/post we will focus on traditional healthcare:

Our family doctors, dentists, OB/GYNs, and pediatricians. In the old days, these professionals defined healthcare for us. We established lifetime or multi-generational relationships with them. They gave us advice, performed preventive and certain simple procedures, and helped us understand the (then) simple costs of maintaining health. We went to them first whenever we had questions or concerns about our health. They referred us to specialists, hospitals and long-term care and followed up to make sure things went well. Well…things have been changing and show no signs of going back to these good old days. For a lot of reasons, the range of help offered is now so broad it’s difficult to say with confidence how much they are doing for us now.

Nurses. Nurses have played central roles in our health for many decades and like family doctors, their roles continue to evolve. Most are employed by organizations — hospitals, physician offices, home health agencies, nursing homes — where they give advice, provide a growing number of tests and procedures, and help us recover from illness.

Specialists helping us diagnose and fix complex problems. The list is too long to detail here and includes physicians, other clinicians, and non-clinical caregivers. It includes acupuncturists and allergists, chiropractors and cardiologists, nutritionists and neurosurgeons, orthodontists and orthopedic surgeons, pathologists and pharmacists. Sometimes these specialists only help us when another trusted health helper (like a family doctor) asks, sometimes they offer help when we ourselves ask.

Our local hospitals. The hospital was a symbol of modern healthcare…in the 20th century. It has been there for us when we need emergency healthcare services, sophisticated testing or complicated procedures, providing us with intensive, expensive places to stay while we recover. Hospitals don’t get credit for a valuable service: financing expensive procedures while navigating an incredibly complex reimbursement environment with health insurance companies and federal agencies. Hospitals are often the biggest employers in communities with its wealthiest employees. Hospitals have been struggling for years to engage us before we need their services, offering wellness programs, preventive screening, and various types of less formal advice services (think Ask-a-Nurse).

Our public and private health insurance companies — past, current, and future. Aetna, United Healthcare, Cigna, Blue Cross Blue Shield, and Centers for Medicare and Medicaid Services are just a few of the bigger ones. Sometimes these organizations merely pay for our healthcare, sometimes they get more involved in aiming for good financial and clinical results. Sometimes they are very involved with caregivers — to the extent that physicians and hospitals frequently consider their involvement disruptive — and sometimes, they are not very involved at all. Sometimes they are very involved with us, providing proactive advice to pregnant women or those of us with intensive chronic illnesses. At other times, we barely know they are there, until premiums are due or there’s some sort of dispute over how much we owe for a doctor visit.

Our public health agencies (CDC, FDA, Department of Transportation, many others). For some of us, our public health agencies provide direct healthcare in clinics. For the rest of us our local, state and federal health agencies operate more in the background. They weave public health messages into our daily lives through media, they regulate the pharmaceutical and food industries, they help tackle thorny social diseases, and help us avoid unnecessary injury on the highway.

Our local schools. Usually overlooked, but essential for all of us are the nurses, counselors, dietitians, and food service people in our kids’ schools and colleges. The support is usually intended to complement others’ help, but continues to be critical nonetheless.

Our parents’ nursing homes and home health agencies. As with our kids’ schools, long-term care organizations have become indispensable, if under-appreciated, supporters of our parents’ health. Nurses and other caregivers are hired to take care of our loved ones for short- or long periods, but they also help identify problems and provide all types of healthcare advice.

We haven’t even tackled consumer healthcare or empowered healthcare, and the options are bewildering. My wife and I have worked in healthcare all our lives, and we could not begin to articulate if and how we could take full advantage of this overlapping web of trusted health helpers that have been available to us all of our adult lives. Like anyone reading this, it doesn’t take long to come up with an example of when help from one organization or person in the list directly conflicted with the help from another organization. We figure out how to resolve the conflicts in some cases, in other cases those decisions seem not to be ours to make. The most ominous type of decision involves payment for healthcare services we will likely need in the next year, or for healthcare services we don’t anticipate. Which of the traditional health helpers should we trust to help us?

Who really is watching out for me, David Morris, and my family? They all are…all the people and organizations above help. Unfortunately, they help for brief periods of time, sometimes minutes. No professional or organization has the responsibility to really look after my health.

How can I benefit from their help without feeling like I’ve lost control? I know I’ll always need professionals to help me, organizations to tackle thorny problems, and technology to make it easier for me. Maybe if I (finally) map out my support system, it will go a long way towards making me feel in control. I could update it yearly like I’m forced to do with my taxes. Then I should be much more comfortable managing overlaps and resolving conflicts among helpers, all the while maintaining as much control as I can.

For what part of my health should I maintain direct control? This is changing all the time. For me, my wife, and definitely for our daughters, there are opportunities to take more control over certain parts of our health, especially with consumer healthcare, explored in the next post. The art lies in finding ways to exercise control over our health while maintaining productive relationships with a complex set of trusted health helpers.

What am I missing? Who could help but hasn’t? I’m missing a lot, because like most people I have never really felt in control even though we are pretty healthy. A big part of what’s missing for us will show up with empowered healthcare, explored in future posts.

Any of the readers would probably answer these questions much as I do. Next week I will dig into consumer healthcare. Until then I should point out that I don’t see any of the types of trusted health helpers — traditional, consumer or empowered — as better than the others. They all have roles to play in my health.

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