Responsibility for your own health

I was shocked to see that the NHS could ban surgery for the obese and smokers.  That’s socialized medicine.  You take a conglomerate group of people (the UK) on a limited budget for healthcare… and basically find the cheapest most cost-effective way to deliver healthcare.  But in a way, it’s empowering patients to take responsibility for their own health.  Smoking, for sure — I agree 100% that surgery should be banned for this population.  Obesity is a bit trickier — there’s genetics and environmental factors at play in this one.  I don’t think anyone chooses to be obese.  But, people do have the power to change their eating and exercise habits.  Despite these efforts, there are some people who are still obese…. and these people should not be faulted.

Why single out the obese and smokers?

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From SlideShare
obesity-and-cv-disease-1ppt-43-728
From SlideShare
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From TobaccoFreeLife.org

Smokers and the obese have elevated surgical risk and mortality, which means more cost to treat and hospitalize and provide ongoing care.

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From HealthStats

I think the NHS is on to something here.  They’re opening doors to moving the liability and responsibility away from physicians and towards patients.  This is a plus.  Outsiders may see it as separatism and elitist to only provide care for people who are healthy.  But look at the facts and the data…. obesity has a lot of co-morbidities associated.  Smoking has a lot of co-morbidities associated as well.  Why should physicians be penalized for re-admissions, poor wound healing, longer hospitalizations when the underlying conditions themselves are already challenging enough?  In fact, I would urge insurance companies to provide incentives to patients/the insured with discounted rates for good and maintained health and wellness.  With all the technologies, medications, and information out there, it’s time patients take responsibility for their own health.  I take responsibility for mine — watching my diet, exercising, working on getting enough rest, maintaining activities to keep my mind and body engaged, meditating for rest and relaxation.  It’s not easy, but my health is 100% my responsibility.  I refuse to pass the buck to my husband, my family, my physician, etc.  I do what I can to optimize my health and future — and if that doesn’t work… I call for backup.

Patients need to change their mindset re: health.  It is not your spouse’s responsibility to track your meds.  It is your responsibility to know your medical conditions and surgical history.  The single most important (and thoughtful) thing a patient can do is keep an up-to-date list of medications, past/current medical history, surgical history, and allergies to bring to every doctor’s appointment and surgery.  This helps streamline and bring to the forefront your conditions and how these will interplay with your medical and surgical plan and postoperative care.  Please do not forget recreational drugs, smoking habit, and drinking habit in this list.  It is very important to know all of these things.  Also, your emotional history is very important.  Depression, anxiety, failure to cope, etc.  This all helps tie in your current living situation with stressors and your medical history.

Links for educating yourself in taking responsibility for your health:

obesity
From SilverStarUK.org
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When to let go

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I came across this blog post and was really struck by it’s honesty regarding the nature of medicine and death/dying. Back in 2011, I was faced with a very real scenario regarding my father’s health. Throughout medical school, we are taught to do no harm. However, there is a fine line between living and just barely surviving. Even as an MD and having been trained to deal with death and dying, I had to eventually come to grips with what was best for my dad. It has been said that medicine is both an art and a science. Practicing the art of compassion and empathy, I have learned a great deal from patients and their families as well as my own. Despite all of the advances of modern medicine, nothing helps more than listening to the patient.

The Greatest Act of Courage

“I’m a doctor”

March 13, 2010

One of my least favorite patient populations: doctors.

This group knows just enough to be dangerous.  They remember what they’ve learned in medical school, but they don’t know enough of the information that doesn’t encompass their specialty.

We had a patient who was a physician, and her husband was also a physician. When it came time for her epidural placement, she wanted an “attending only” placement (i.e. didn’t want a resident to place her epidural).

(Note: my hospital is a teaching hospital; there’s no question about it. Most large academic centers are run by residents.)

So, we go in to place her epidural and her husband refuses to leave the room.

(Note: it’s a policy at our hospital to have the husbands/significant others/partners, to leave the room and then come back when the epidural is placed — plenty of significant others have passed out…even when sitting in FRONT of the patient. Moral: don’t turn 1 patient into 2!).

He was interfering in every way possible. And because the staff know that this patient and her husband are physicians, they feel the need to change up their care by trying to do things different from routine. She got her epidural… by the staff. She’d been having late decels…so when she got the epidural, it was just a matter of time before going back for a cesarean section. The baby was known to have IUGR…it was delivered by C-section and went intubated to the NICU. The patient had various episodes of freakout (not uncommon on OB when you’re awake but being operated on) — as told to me by another resident who took care of her in the OR. The husband was walking around all over the place on the OB floor like he owned the place. Ugh, just b/c you’re a doctor doesn’t mean you get to prance around and receive “super special privileged” care over the normal population.

When it’s time for me to be the patient, you can bet that I won’t be anything like these people. Oh wait, I’ve already been the patient!