The New Age Of Sickness And Scarcity: How do we respond? Introducing Entry Level Clinical Nutrition™ - Part I
Introducing Entry Level Clinical Nutrition™
“…a tidal wave of chronic illness…”
“The United States is doing an especially rotten job of delivering chronic care, at a spectacular cost.”
Last year, The New York Times wrote an article about medical students from the University of Washington who spent the summer working in medical clinics that were located in areas hard hit by the recession. The article, titled, “Summer of Work Exposes Medical Students to System's Ills” showed the stark reality of treating sickness in today's U.S. health care environment.
What caught my eye about this article was a quote from one of the students. He said America was experiencing “...a tidal wave of chronic illness...” The student was shocked by the sheer number of chronically ill patients jamming the clinic where he worked. He was amazed at the prevalence of ailments such as diabetes, hypertension and obesity.
Almost every health care practitioner is familiar with this phenomenon – a constantly growing group of chronically ill patients. Many of these patients present with highly complex, highly varied lists of signs, symptoms and diagnoses. At the same time, despite being treated repeatedly for their illnesses, few of these patients ever “get better.” Instead, they receive an endless number of treatments for ongoing, acute exacerbations of their ever-expanding list of chronic ailments. These patients carry around a “ball and chain” of disease for months and years.
More Challenging Illnesses
Susan Dentzer, editor-in-chief of the journal Health Affairs, wrote about this situation in a January 2009 editorial:
“Three-quarters of the $2 trillion-plus that we spend on U.S. health care each year goes to paying bills for chronic illness: cardiovascular and pulmonary disease, cancers, diabetes, arthritis, high blood pressure, depression. Globally, the World Health Organization estimates three out of every five deaths – four out of five in low- and middle-income countries – stem from chronic disease.”
The evidence suggests that we've entered a new world in health care, a world of increased sickness and more challenging illnesses. Add to that the fact that it's also a world where health insurance covers less and less; co pays – if there are any – are higher and higher; and personal income is lower, leaving fewer dollars available for health care. Meanwhile the cost of care continues to go through the roof.
Redefining Our Goals
To treat patients effectively in this new environment of sickness and scarcity, it seems to me that we need to redefine our goals. I believe that, today, successful patient care means focusing on achieving an optimal patient outcome, as defined by the patient.
In other words, we must increase the chances that each patient's chief complaint will be resolved to his or her satisfaction.
Take the example of the patient whose cholesterol, triglycerides, and blood pressure are optimal but feels constantly fatigued and out of sorts. Or the patient whose previous health care provider seemed to care more about weight loss and clear skin instead of the chief complaint – a persistent headache – that brought the patient to that provider in the first place.
Certainly, resolution of secondary patient issues should be commended. However, in the eyes of patients who are living in this new world of sickness and scarcity, the chief complaint is increasingly important. Patients want that key complaint resolved in a time efficient, cost efficient manner. Unless that happens, the patient's evaluation of our care will not be positive – no matter how well we resolve secondary issues.
In this challenging and demanding situation, how do we respond?
A Major Impact
Fortunately, as I will discuss in following entries in this blog, a very effective response is available to all of us. The concept is called Entry Level Clinical Nutrition™ because it provides an “entry point” to the clinical use of nutrition to treat chronic illness. While the name may not be very familiar, nutritional practitioners and other clinicians have used this approach for many years.
In my next post, I'll begin to talk about this important approach. I'll explain how it differs from the methods many practitioners currently use to address chronic illness. And I'll begin to show why Entry Level Clinical Nutrition™ can have a major impact on the satisfaction levels of both patients and practitioners.
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