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The Integrator Blog. News, Reports and Networking for the Business, Education, Policy and Practice of Integrative Medicine, CAM and Integrated Health Care. - Holistic Leader Bill Manahan, MD: "My Tenth Idea - Revisioning Healthcare for 2009"
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Holistic Leader Bill Manahan, MD: "My Tenth Idea - Revisioning Healthcare for 2009" PDF Print E-mail
Written by John Weeks   

Holistic Leader Bill Manahan, MD: "My Tenth Idea - Revisioning Healthcare for 2009"

Summary: When past president of the American Holistic Medical Association Bill Manahan, MD received the list of the Integrator Top 10 from 2009, he was inspired to create a list of his own. Manahan, an Integrator adviser and long-time member of the clinical faculty at the University of Minnesota School of Medicine, offers what he calls "eight transitions that will bring light and balance to healthcare." What are your thoughts on these directions?
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Bill Manahan, MD, decided that, rather than merely offering his ideas for #10 in the Integrator Top 10 from 2008, he'd set out a set of "eight transitions" that he believes should guide healthcare reform in 2009. Manahan, a family practice, holistic physician, explained his approach to the column this way:
"Being a generalist, I tend to view the bigger picture most of the time.  So much of the discussion I hear about health care reform is about one aspect of a messed up system.  We need single payer!  We need healing environments!  We need health and wellness and prevention!  We need malpractice reform!  Etc.  So, I came up with this list of what I felt were some of the core issues that will help move the health care system in a beneficial direction.

"Our health system is similar to a dike with 15 holes in it.  It is nice to plug up one hole, but it will probably not be all that beneficial unless we plug all the holes or build a new dike.  So, if we try to keep looking at all the holes in the system as we move forward, it will hopefully help us arrive at more holistic solutions."
Manahan's recommendations range widely, from shifts in directions set a few hundred years ago to better honoring of the role of the community in health care. The recurring theme: balance. What's not to like here? More important, where are the initiatives that are actualizing these transitions? Who is carrying this water via practical programs into the Obama-Daschle reform dialogue


Revisioning Healthcare in 2009

Eight Transitions that Will Help Bring Light and Balance to Healthcare

-  Bill Manahan, MD

Bill Manahan, MD
1.   The Transition from a Business to also being a Calling

The practice of medicine has become more of a business than a calling.  Previous to the sixties, medicine, nursing, and other health care work was primarily a calling for those involved. The business aspects of health care were not usually a determining factor in how medicine was practiced. Working with patients was considered by many to be sacred.  A majority of practitioners felt it was an honor and a privilege to be able to serve people and work with people in such an intimate and trusting way.  Many at that time would even go so far as to say that there was something spiritual about being a doctor, a nurse, or other healthcare provider.

Sometime during the 1970’s, there began to be a marked shift from medicine being primarily a calling to having it become a business.  Doctors became providers taking care of clients.  Young doctors began to have increasing concerns about salary, what hours they worked, and how much vacation time they had.  A major transition of both hospitals and medical clinics was that they began to follow the lead of most other American corporations in that their highest priority was to maximize profits.

Revisioning healthcare will honor medicine being both a service and a business.  The sacred calling of healthcare will be balanced with a sensible approach to economics and profit.

2.   The Transition from the Dominator Model to also being the Partnership Model

Because of the United State’s support and acceptance of the dominator model, the healthcare field continues to operate from a model of competition, profit, and hierarchy rather than one of collaboration and partnership.  Our nation and our healthcare delivery system are based on a model of “what is good for me” rather than one of “what is good for all of us.”

3.   The Transition from Science to also being an Art

Since Copernicus in the 16th century proved that the earth was not the center of the universe, there has been a 400-year shift in which science has been the major paradigm.  Unfortunately, like many necessary and healthy transitions, it shifted us too far toward a material, mechanistic, and scientific world view.  Almost left out of the equation have been consciousness, mindfulness, and spirit.  Just as it is important to have a balance between medicine as a calling and medicine as a business, it is also important to have a balance between medicine as an art and medicine as a science.  The art of medicine demands that consciousness and spirit be centered at the core of all healthcare.

4.   The Transition from focusing on Individual Health to also focusing on Community Health

When there was little that could be done to truly help individual patients with their illnesses, the role of public health was a major factor in improving the health and longevity of the people of our nation.  Such innovations as clean water, sewage disposal, environmental safety, and food processing regulations made dramatic improvements in the health of our citizens.  In the 1940’s, as antibiotics and other major pharmaceutical and surgical advances began to occur, we shifted our priorities and our funding to where the vast majority of our resources, research, and energy was put into the medical care of the individual. Again, a balance of these two paradigms would help bring better health to many more people.

5.   The Transition from Unrealistic Expectations of the Medical System to more Realistic Expectations of the Medical System

As many new medications and surgical procedures were discovered, people began to have unrealistic expectations and perceptions of what medical care can actually do for someone.  Medical care tends to excel in and even cure many problems or illnesses that have one clear causative factor.  Examples are broken bones, many surgical problems, and infections caused by one invader.  For long-term and chronic diseases, the magic of medical care is not nearly as successful.  Pharmaceutical advertising directly to the public since 1995 has increased the public’s expectations dramatically.  We are primed for people to begin to truly understand what medical care can and cannot do for them.

6.   The Transition from Type II Medical Malpractice to No Malpractice or only Type I Medical Malpractice

Nortin Hadler, MD, in 2008 wrote a book titled Worried Sick in which he described the large increase in what he calls Type II Medical Malpractice.  Type I is when we do the right thing the wrong way.  Type II is when we do the wrong thing the right way.  He gives many examples of our medical system doing inappropriate procedures, testing, and treatments that are not evidence-based.  Hadler’s conclusion is that a majority (greater than 50%!) of medical care now practiced in the United States is Type II malpractice.  Examples include a majority of coronary artery bypass grafts, angioplasties, stents for a majority of people having those procedures, arthroscopy for arthritic knee pain, most backache surgery, using drugs for decreased bone density, prostate specific antigen screening and radical prostatectomy to save lives, and many of the cancer treatments used to save lives. 

Again, it has been a problem of moving a system, a paradigm, or a cultural belief too far in one direction.  Once the pendulum of change begins to move, it seems quite difficult to stop it in the middle where there can be more of a balance of many beliefs, options, and ideas.

7.   The Transition from Living in Fear of Illness and Death to Acceptance of Illness and Death as a Normal part of life

Until the early 20th century, it was not uncommon for a family of eight children to have four of them die in childhood.  Death of an adult in his or her forties was not uncommon.  As these types of occurrences became less common, the citizens of the United States seemed to swing from a fatalistic acceptance of illness and death to an almost hysterical fear of both of them.  In fact, some believe that this paradigm shift may be the single biggest problem within our health care system at this time.  This fear is a major cause of what has led to excessive testing, treating, and even illness itself with the stress and fear people feel about becoming ill, discovering cancer, or a host of other worries and concerns.

The fatalism of our forefathers regarding illness and death is, of course, no longer appropriate, but neither is the morbid fear of illness and death that now exists in a majority of the citizens living in the United States.

8.   The Transition from Single causality to an understanding and acceptance of the multiple causality of disease

Most of the significant health problems now experienced by our citizens are caused by multiple factors.  We all know the list of chronic diseases that are believed to be responsible for approximately 80% of healthcare spending in America.  Every one of those chronic diseases has a long list of factors that can be contributing to them.  Therefore, a medical system designed to handle single factor illness (trauma, broken bones, emergency medical problems, single cause infections, surgical problems, etc.) is often not appropriate for managing the many causative factors involved in those chronic diseases.

Comment: I wonder whether Obama's healthcare team has a plan, after distilling the offerings of the masses via the Daschle Community Health Care Discussions, and of its own anointed experts, to begin its work with a collective visioning experience. Will it allow itself out of the box? How much will the idea of the idea of advancing a wellness society be taken seriously? How big will the course corrections be? How and in what ways will such profoundly re-shaping transitions be allowed into the room? Who is pushing them?

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