Re: Applications in Medicine

[Dan Fiscus <***>]

Tom and Judith,

Jumping in here with some comments re: health care
paradigm and redesign...

Tom Staiger wrote:
> Judith Rosen wrote:
>      In any case, to put patient care as the prime focus of medical
>     systems in an anticipatory model would, I hope I've managed to point
>     out, require a return to square one for a complete redesign. 

> *I would agree that an optimal system would benefit from a redesign 
> around a new paradigm.  snip

My first set of comments stem from recent experiences as
a support person, family member and patient advocate
who spent a lot of time in hospitals with my Mom in the
last year of her life as she dealt with cancer, broken hip
and replacement, septic shock, hospice care and eventually
death. My second set of comments stem for my sense as
an ecologist and environmental scientist that holistic and
long-term health for humans should start to include the
health of our environment at each step. To ignore this is
like the fable of the doctor who kept fixing broken legs
and was very good at it but never looked outside his
window to see that patients with broken legs were being
generated (bad health caused by) a big pothole on the
sidewalk. If he had been able to shift gears and see the
big picture he could have switched to pothole filling (an
analogy to care for the environment) and saved himself
a lot of needless medicine. Going even another level
deeper we might say that non-relational science is the
ultimate cause - an active force that goes around creating
new potholes (environmental problems that harm human
health).

When my Mom was in hospital I was struck by how little
coordination went on between the various specialists that
treated her. The respiratory techs did not know what the
diet people or rehab people or anyone else was doing.
Even within a specialty there was no continuity between
shifts. One time I watched a respiratory tech learn that
Mom's index finger was not good for getting O2 saturation
levels. As the next resp. tech guy later fumbled around with
trouble getting an O2 sat. level on Mom, I pointed out that
her thumb was better. Simple benefit of "being there and
paying attention" plus info sharing between shifts. And
there was no basic sense of caring for Mom's basic needs
like sleep. One time I helped her get up to go to the
bathroom at 5 a.m. (hard, slow and painful to move across
the room with a broken hip) and as soon as she got settled
back into bed to rest and sleep a nurse's aid came in with a
scale and said loudly "OK time to get your weight". I was
right there and this person could have asked me for info
on the "context" and whether a good time or not for the
mundane task of weighing Mom. I jumped up and said "no
way" in this case. That's another pet issue - "the system"
does not seem to value the insights, knowledge or help of
family. What a missed opportunity. When Mom was in
Intesive Care things were better and the better quality
seemed due to the fact that a single MD was in charge of all
goings on and was actively coordinating. I have about a
million other experiences and many pages of detailed
notes and documentation if anyone interested.

The environmental issue is that we humans are so narrow
minded and short sighted and reductionist that we could
probably extend the lifespan of an individual to 150 years
at the same time as destroying all life support capacity in the
forms of the other species and ecological relations that are
fully necessary for human life. This selective ignorance can
be seen in efforts like that of Bill Gates foundation to cure
major diseases and increase vaccinations without any work
(that I have seen) to address ecological life support capacity
(renewable energy, sustained soils, farming, air, water, etc.)
for the millions of lives they'd like to save. On this issue I
have another million ideas, notes and experiences if anyone
is interested. At the theoretical core is an issue that we have
discussed much that I see life as having two forms - a
discrete form that is the cell/organism and a continuous
form that is the community/ecosystem. The continuous
form needs equality with the discrete form for holistic health
to be visible and make sense and be achieved. All of this just
in my opinion...

Both my parents are/were physicians (Dad is still practicing)
and to carry on their legacy but altered with my focus on the
environment and ecology as key to human life (as well as
life itself) I see myself as a meta-physician :-) I also see key
roles for humans to aid life as a unified whole and so I am
geniunely interested in humanity evolving to avoid
extinction. To heal our bodies we may need to start with
healing our minds or philosophies, fixing the broken ideas
with still think with...

Dan