Healthcare Thanksgiving Blessings

With Thanksgiving just a couple of days away, I thought I'd dedicate this week's post to recognizing some things in healthcare that I'm thankful for.  I'm not saying our healthcare system is a turkey, but, well, you'll see.

I'm thankful for all the smart, caring people who work in healthcare. Not everyone who works in healthcare is either, of course, but, amidst all the craziness of our healthcare system and the stress that health issues can generate, I've almost always encountered some people who are knowledgeable, helpful, and comforting.  That people still go into the field, and stay in it, because they truly want to help is a testament to what we'd like to believe about humans in general and healthcare in particular.

But we make it too hard for them: so many rules, so much pressure, so many competing priorities.  Our first goal should always be to help the patient, but a close second should be to help those who are trying to do just that.

I'm thankful for all healthcare can do.  The changes just in my lifetime have been astonishing.  Organ transplants, bypass surgeries, saving ever-smaller premature babies, new cancer treatments, sophisticated imaging, genetic treatments, laser surgeries, to name a few.

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It's less clear that we really know what to do with all these.  Many new cancer treatments are hugely expensive yet only yield a few additional months of life, and not necessarily high quality months.  Some of those premature babies have lifelong impairments, and expenses.  There are too many people we keep alive who are not "living" in the sense they'd hope for.  We need to remember: just because we can do something, doesn't mean we always should.

I'm thankful for genetic gifts that gave me the opportunity for good health.  I won the genetic lottery: I like to exercise, and I don't have any chronic conditions.  My life -- and my encounters with the healthcare system -- would be much different if I had health issues that imposed barriers to active living.  However, many go through major portions of their lives worried about their next health crisis or circumscribing their activities due to health reasons.

The healthcare system should not be about simply helping keep people alive, but about helping to improve the quality of those lives.  It should maximize what everyone can do with their lives.  It's easier to treat than to prevent, it's easier to fix than to avoid.  When we allow the healthcare system to be reactive, rather than proactive, we are stealing parts of people's lives.

I'm thankful for not having had major health expenses.  Don't get me wrong; I've had significant health expenses, have a large deductible, and pay a lot in health premiums.  But, fortunately, I've had health insurance that picked up my biggest bills and was able to finance the rest without undue burden.

Not everyone is so lucky.  Too many are crushed by health expenses, whether through a single catastrophic event or a series of ongoing expenses.  Too many have no insurance or inadequate insurance, too many are hit by surprise bills, and too many avoid care due to its costs.   The healthcare system shouldn't be a financial burden on people when they are least able to deal with its financing.

I'm thankful for having more options for getting care and advice.  Hey, I like Dr. Google; I don't believe everything I find, nor can I find everything I hope for, but reducing the information asymmetry with the healthcare system is empowering.  I like having options like retail clinics, urgent care, telehealth, and more outpatient centers.  The increase in these various options over the last 20-30 years has been staggering, and is only beginning.

We're still too office and institutional oriented.  Healthcare should strive to be more like other sectors of our lives: get people as much of what they need where they are and when they want it.  We've improved the availability of options; now we need to make sure that availability is not a false promise.

I'm thankful for exciting new technologies.  As regular readers know, I'm a sucker for robots of all sorts, A.I., and virtual reality.  I'm excited by the options increased processing power and miniaturization are giving us for wearables and the internet-of-things.  I can't wait for A.I. "doctors."

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Healthcare still is having a hard time figuring out how all these fit into its ecosystem -- e.g., who gets paid, how?  Who controls?  What to do with all that data? -- and how health tech should be like other tech, especially in terms of usability and diminishing costs.  The line between "healthcare" and the rest of our lives is going to become very thin.

I'm thankful to be on the cusp of the biological revolution.  It's been 175 years since Pasteur helped solidify the germ theory of disease, and not quite 100 years since we discovered our first antibiotics.  Healthcare has changed radically due to these, and perhaps we got a little too confident that we understood our bodies.

Now we're starting to recognize that we share our bodies -- and our health -- with an extensive microbiome.  We don't really know how to ensure its health to ensure "our" health, but at least we recognize that it is an issue.  Equally exciting, we're starting to think about "programming biology," connecting tech with biology.  All of this is going to mean healthcare in the next few decades will look very different than healthcare does now. 

I'm thankful our healthcare system isn't worse.  I wish I could be more positive about it.  My encounters with it haven't ended too badly, but I've been relatively lucky.  There are way too many people whom our healthcare system fails.  Our morbidity and mortality statistics are at best middling, and, for some sub-populations, third world.  All for the most expensive healthcare system in the world, by far.

Credit: Mengxin Li/The New York Times

Our healthcare system is a conglomeration of many systems that have evolved from a variety of initiatives and decisions.  It wasn't "designed" in any meaningful sense, and it doesn't have a clearly articulated purpose.  We could do worse, but, seriously, we could do a lot better, and we should.

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Wishing you & yours good health and only good encounters with the healthcare system, and hoping for more ideas about how to bring about both.