It still amazes me when what seems like common sense is not seen as such by others. My mom taught me early on that, "There is nothing common about common sense," and I think of that statement almost every time I watch the news reporting riots and war or read a controversial article.
Different sides of an issue help understand alternate points of view. Controversy is a valuable resource for growth, both as individuals, and as a country. Some things, however, seem so obvious that when they become controversial it is mind boggling.
The reaction to the mayor of New York's recent proposal to limit large-sized sugary drinks is one of those "seems like common sense" examples. Decreasing sugar and salt in our diet seems like common sense; however, the "man on the street" interviews indicate that people think otherwise. People believe that, "The government should not be telling us what to do!" Really? I appreciate and agree that government should not be dictating what we eat or how we conduct our lives. However, government assumes some responsibility for informing us about what we can do to keep ourselves and the rest of society safe and secure. The law tells us we cannot commit homicide, we cannot drive at unsafe speeds, we cannot drink or text while driving, we must wear seat belts and buckle up our kids, etc. The government is responsible for making us aware of environment dangers and informing as to how to stay safe and healthy.
Mayor Bloomberg wants New Yorkers to be healthier, so he is attempting to legislate limits for sugar and salt consumption. That sounds like common sense, yet it is apparently extremely controversial. The very fact that he is talking about it, however, has made consumers and the beverage companies more aware that there may be excess sugar in these drinks and our diets.
Certain health issues are clearer and less controversial. A lab value is either within normal limits or it is too high or too low and needs to be addressed. A blood pressure reading is either normal or it is not and needs to be addressed. One's weight is within a reasonable range or it is not. There is such a thing as too thin or too fat and neither is healthy.
A recent Time magazine issue, March 4, 2013, was devoted almost exclusively to the high cost of health care in America and focused on the excessive, unreasonable and opaque charges of hospitals and doctors. This was further compounded by reported poor patient outcomes in America compared to other countries. The article was disturbing and eye opening from many perspectives. However, there are underlying issues that were not addressed but affect our high health care costs and poor patient outcomes.
First, the outcome measures used were ill-defined. The expectations of Americans and those people from other countries are not necessarily comparable. Despite the fact that Americans do not always follow their doctor's advice, Americans have a unique sense that their physicians are responsible for their health and medical outcomes. How pain-free is pain-free supposed to be? What range of motion is expected and acceptable? Is being told to restrict one's diet considered healthy or unhealthy medical advice, or is it just advice that can be ignored?
Advertisements validate the concept of unrealistic expectations. There are prescription medications being marketed directly to the public to make us sleep better, medications to make us more awake for 4-5 hours, medications to assure us a better sex life, medications and surgical treatments to help lose weight, medications and surgical treatments to help look 10-20 years younger, etc. Who is to judge what constitutes a good outcome? Is the definition of "good outcome" the same in America as it is in other countries? Is a "good outcome" interpreted the same way for the physician as it is for the patient?
Second, what are our "end of life" expectations? Many American health care dollars are spent for "end of life" heroic efforts when the extension of life only entails serious physical and/or emotional pain and suffering. How does the American expectation compare to that in other nations and how much money is spent on "end-of-life" decisions?
Third, we measure statistics for patients' outcomes after surgery or medical care, but what about the health of the patient at the time he/she presents to the physician? Is the patient a smoker? Does he/she have diabetes? Is he/she obese? These are just some of the factors that affect response to medications, treatment regimens and surgical outcomes. These factors seriously influence the cost of care. To prepare a smoking, obese and/or a diabetic patient for surgery and recovery is problematic and can be extremely costly. The outcome and cost to the health care system for these patients is not the same as it is for an otherwise healthy, non-smoking, average weight individual.
If the American population is out of shape due to poor exercise, too much sugar, too much salt, etc., can the outcomes of the American population be expected to be stellar? To what degree can we hold the physicians, surgeons and hospitals responsible for reported longer length of hospital stays and poor outcomes?
More recently, attention is being focused on the physician being responsible for preventing illness and injury and not just treating chronic illnesses and complaints. Eliminate smoking and cutting down on sugar and salt intake are health messages for all to heed, e.g., "garbage in, garbage out." The high cost of health care in America should focus on our diet and lifestyles as well as outcome expectations. There is an old joke: Patient asks the doctor, "Will I be able to play the piano after my hand surgery?" Doctor answers, "Yes." Patient responds "Great, because I've never been able to play the piano."
Individuals need to have realistic medical outcome expectations and live healthier, including watching what they eat and drink. It is the responsibility of physicians, health care professionals, and those in leadership roles to advise and make others aware of ways and means for illness prevention. Perhaps with regard to health, health care and health care costs, it is time for a bit of "common sense."
For more by Helene Pavlov, M.D., click here.
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