Paradigm Shift Please: Reactive to Proactive; Illness-Based to Wellness-Based

Yesterday evening I had the good fortune to participate in the first half of the weekly Healthcare Leadership chat (#hcldr). As always the audience was filled with a combination of clinicians, patients, advocates, techies, community builders and those of us who don many hats. As always the conversation was rich and thoughtful. And, as sometimes happens, there was a tweet that stuck with me for hours and my 140-character response feels insufficient to address the concerns I have.

The conversation and the chat questions revolved around the similarities, differences and potential applicability of humanitarian efforts, like those of #hcldr guests Doctors Without Borders, to population health. Again, relaying the richness of the conversation is not my intent and will not be relayed in this post. Instead a single tweet seems to enunciate for me one of the challenges we have in healthcare today. And, as the oft-quoted G.I. Joe reminded me and countless others in the mid-80s, “Knowing is half the battle.”

The second chat question was “What should be the standard of care in low resource settings?”

My initial response was:

Always start w/ patient goals, regardless of zip code. MT @hcldr: T2: What should be standard of care in low-resource settings? #hcldr

— Stacey Tinianov (@coffeemommy) October 28, 2015

As I typed, I realized how ethnocentric my response was. Zip Codes is US terminology. Fail. My intent was to convey that regardless of where a person lives, or their forced standard of living, their personal choices should absolutely be respected.

The T2 response that raised the hairs on the back of my neck was the following:

T2. In resource limited setting even more important that the standard be prevention rather than treatment #hcldr

— Brian Castrucci (@BrianCCastrucci) October 28, 2015

Depending on how I read this statement I either agree or vehemently disagree:

• In a resource limited environment, prevention or risk reduction should be fundamental. AGREE.

• In a resource rich environment, prevention/risk reduction is less important and treatment after the fact is okay because it’s available. Vehemently DISAGREE.

After a bit of a back and forth online, I am 100% convinced Brian intended his statement in the manner with which I agree. However, the statement and the conversation bring up a much bigger issue and a much bigger reality.

Our US healthcare system, in a resource rich area rife with pockets of inequality, is an illness based system. By and large we wait for people to get ill, treat them, treat the side effects of treating them and then treat them when the original medicines/treatment produces unintended negative consequences.

Focusing on risk reduction and prevention where prevention is possible is THE absolute way to go, regardless of zip code, latitude, longitude, ethnicity, socio-economic status or any other defining characteristic demographic. There is absolutely no such situation where improving heath literacy, personal accountability for health and striving to reduce the incidence of disease doesn’t make sense.

Resource limitations are relative. In instances where clean water, shelter and food are scarce, resource limitations are obvious. However, when we look at elements like clinician burnout, appointment backlogs, insurance reimbursement backlogs, caregiver energy, patient emotional well-being, caseload overload, etc. we can and should consider such resources as limited. The mindset that, in ‘resource rich’ areas we have the luxury of focusing on illness treatments rather than reducing incidence and prevalence of illness is, to be blunt, bass-ackwards.

Nearly a year ago, I created a flip idea based on generating incentives to shift from an illness based into a wellness based system. Flip 28: Create Preventive Care Incentives: Incentivize patients for on-time wellness and preventative care. 

Admittedly, this was my first flip and the content was lacking some of the specifics that would have made it easily actionable. But it is still a damn good idea. I’d like to resurrect the idea and join forces with those who already see the incredible need and benefits from shifting from reactive to proactive mode in healthcare. I’d also like to help highlight people and organizations that have achieved success with a preventative care model because, for some, the catalyst for change is the ability to visualize prior successes.

Just because people can afford treatment doesn’t mean that treatment is the ideal course of action. Imagine the emotional and financial benefits to reducing illness risk in individuals and preventing illness in the population. Imagine the luxury of a system not overtaxed with sick that has the ability to spread valuable resources to areas that require treatment. Imagine a healthcare system that focuses on protecting health rather than trying to re-establish a quality of life after the devastating impacts of chronic disease.

In partnership with others, I’d like to shift the paradigm from: “In a resource limited environment, prevention or risk reduction should be fundamental” to “In every environment, health education and support to drive personal risk reduction and population disease prevention is fundamental.”

Please let me know if you’d like to help.