From the President of the IMA Board, Winter 2008

The current focus on healthcare is expressed primarily in financial terms: dismay over the amount of the Gross National Product going for healthcare, the cost per individual for healthcare, the cost of each American-made new car that derives from healthcare expenditures and the skyrocketing cost of health insurance are all constantly in the news.

Practitioners, whether of conventional medicine or complementary/alternative medicine (CAM) know that time is the essential ingredient for quality healthcare. Under our current privately insured healthcare system, time is not seen as valuable and thus is not reimbursed appropriately. The results are clear: declining quality of patient experiences, declining quality of practitioner experiences and progressive disillusionment with our current healthcare.

Ironically, as the time spent between patients and conventional practitioners continues to get briefer, the amount of testing increases in the hope of making diagnoses without adequate histories and examinations. As the testing increases, the cost of healthcare rises.
Needless tests and confusing results create even greater costs, both financially and in terms of personal suffering and inconvenience.

Poor quality assessments are not the only issue. In terms of treatment, inadequate time for thoughtful treatment plans and reliance on pharmaceuticals as well as on money-generating procedures again increases costs. A good example is in the area of cardiovascular disease, now the most common cause of death on the planet. It is estimated that in the United States (where more than 2000 people die each day from cardiovascular disease), 90% or more of cardiovascular disease is preventable with appropriate nutrition and lifestyle changes. Yet, we continue to focus on bypass surgery, angioplasty, coronary stents, pharmaceuticals and now on possible genetic treatments for cardiovascular disease.

Procedures and pharmaceuticals generate money quickly. Lifestyle and nutrition changes take time. There needs to be time for practitioners to convince patients to make appropriate changes. There needs to be time for patients to learn about the changes and to incorporate them in life. There needs to be time for reinforcement of behavioral changes. There needs to be time for commercial interests to learn that they can still make money from healthy nutrition and lifestyle activities pursued by patients. Restaurant and fast food menus need to evolve; that takes time.

Cardiac rehabilitation is a great laboratory for the evaluation of the effectiveness of time and repetition. Studies show that attendance at cardiac rehabilitation after heart attack or cardiovascular procedures improves outcomes, prevents recurrent events and results in better quality of life.  In spite of these facts, few patients end up getting appropriate    cardiac rehabilitation. It takes time to refer people, to convince them to go, and even for practitioners to gain the knowledge convincing themselves to refer patients.

Conventional medicine is lost in a downhill spiral of money, speed, demands for “more efficiency,” and reliance on technology and pharmaceuticals, rather than on the appropriate relationships between practitioners and patients that can result in thoughtful diagnoses and treatments, utilization and fostering of self-healing abilities and the wonder and magic of great human relationships.

It is no surprise that people progressively seek CAM practitioners who continue to see time and human interaction as important aspects of healing. The results of a patient seeing a CAM practitioner can be from the relationship with the practitioner as well as from the specific practice experienced. It used to be that way with conventional medical practice, and fortunately, it still is with some conventional practitioners. The current system of conventional medicine makes the possibility of beneficial relationships between practitioner and patient progressively less likely.

Other areas in conventional medicine that have deteriorated from time constraints are the areas of collegiality and education. Time-stressed practitioners do not spend time with each other, sharing experience and knowledge as well as building personal relationships that can often smooth individual patient experiences. Furthermore, time-stressed practitioners often skip routine educational meetings such as medical grand rounds.

The current pattern of using hospitalists (physicians who only follow patients in the hospital) for in-patient care can present further difficulties. While there are benefits for very sick people in having physicians on-site during acute, serious situations, inpatients are now routinely deprived of the supportive relationship they may have with their primary caregiver.  Furthermore, a practitioner with a long-standing relationship with a patient can lend history, knowledge, intuition and continuity to a patient’s care that hospitalists may not be able to provide. As the hospitalists system is extended, some role for primary caregivers needs to be built in to benefit both patients and caregivers.

The practice of medicine means to see a patient, learn from that experience and then carry the learning on to the next patient. With interactive time between practitioners and patients cut so short, the practice of medicine is limited in the learning possibilities and ends up being a series of chores, like an assembly line. Over time, the possibilities and potentials for increasing the wisdom, insight and intuition of a practitioner get progressively limited with the result that there must be a decrease in the quality of healthcare.

CAM practitioners may also suffer from time constraints if they seek to pattern themselves after conventional practitioners. One of the few benefits that CAM practices have gotten from being denied insurance coverage is that CAM practices don’t have to suffer the time restrictions imposed by insurance reimbursement.

CAM practitioners provide healthcare with many benefits. Besides the efficacy of their given practices, CAM practitioners can provide time, listening skills, respectful interaction, repetition and attention to environmental aspects of healing such as color, music, aroma and other sensory inputs that can facilitate healing. CAM practitioners have time to provide education and they generally focus on people’s strengths rather than just on their problems. CAM practitioners do assessments more based on obtaining histories than on tests and can provide safe environments for people’s inner exploration and growth. CAM practitioners tend to look at people holistically rather than as broken parts. CAM practitioners are often very adept at therapeutic use of self and have the time to put that therapeutic use to work.

Conventional medicine has some extraordinary tools, including powerful technology and pharmaceuticals. How those tools are applied is extremely important. Assessment of when the tools are to be used and on whom requires adequate patient–practitioner interaction time, and the patient–practitioner interaction can help or hinder the efficacy of the tools. Conventional healthcare can relearn from complementary/alternative medicine about the value of time spent in practitioner-patient relationships.

The healthcare system in the United States must pay attention to reimbursing time spent and to rewarding relationship time between practitioners and patients if quality is to really improve in conventional healthcare. The idea that, “If we just apply the right test and give the right pill all will be well,” is a major misconception among administrators and insurers. If CAM practitioners are to be included under insurance reimbursement, they need to help correct the reimbursement patterns that reward testing and procedures more than human interaction.

All healthcare providers, conventional medical or CAM, and all healthcare receivers must advocate for appropriate reimbursement for time spent between caregivers and care receivers. Talk about this subject. Lobby your legislators. Send letters and emails to your insurance companies. Inquire from your political candidates what they are doing about this issue.  Write about it. We, conventional and CAM providers and receivers, can help change our current system of care.

We can look forward to a medical care system that appropriately allocates money for human interaction, as well as for technology and pharmaceuticals. We can look forward to a system that appropriately integrates and reimburses conventional and CAM practices, all with adequate time for well-trained individuals to practice high quality healthcare. Let us re-orient healthcare to human caring with the magic of supportive, loving respectful human interactions and technical, chemical and energetic tools only applied when and where appropriate.

Respectfully,
Harvey Zarren, M.D.
President, IMA Board of Directors

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