Archives for category: health care provision patient centred health provision

Unfortunately we live in a world in which, unless we can put a monetary value on something we tend not to value it. Our valuations are all done in terms of price and cost. We value objects that have a high price on them and people who are described as ‘wealthy’. We describe the latter as having ‘made money’ whereas unfortunately their skill is to collect it off other people.

I was reminded of this the other day when I attended a presentation on a new ‘hospital’ which is soon to be opened in this area. For many of us it is not a proper hospital as it doesn’t have either an emergency department or facilities to do operations. What they are building is not what most people regard as a hospital but in describing it as such the government can claim to have built another ‘hospital’. Elections next year!

At the meeting I raised the question about preventative medicine. This was dismissed as trivial. If you ask people what the major medical discovery was last century nobody will suggest preventative medicine, yet this was really a big step forward. Because it wasn’t the result of major research and huge amounts of money we ignore it yet this was the only medical breakthrough achieved which affects everyone and can improve lives and health.

The three major problems facing developed countries today are obesity, diabetes and unhealthy ageing. Yet this brand new medical facility, which is priding itself on having state-of-the-art procedures, completely ignores these three issues. How much money we could save, and how much healthier and happier people would be, if we put resources into enabling people either to prevent these chronic diseases from occurring, or, if we can’t do that, at least reduce the impact of them.

What adds insult to injury for me is that the people who present talks on new health developments are often overweight and under fit themselves and don’t even seem to realise that they have a problem.

I’m told that Bhutan doesn’t have a measure of gross domestic product, putting everything in monetary terms, but rather measures gross domestic happiness instead. How sensible.


I have just come back from a conference on the coast on aged care and feel so refreshed. I hadn’t realised until I got home just how bogged down I had been in everyday life.

I deliberately chose a motel to stay in which was in walking distance of both the conference venue and the shops, yet was on the riverfront. I was able to park my car and walk everywhere. When I went out it meant a walk along the side of the river with quite a lot of bird life and little pedestrian or car traffic. I could even see the river when I sat outside my unit. Peace. Watching the tidal flow was also a reminder of the bigger world we are part of.

Most of the other conference participants were people involved in the ‘hands on’ care of older people. These professionals are the salt of the earth. If we had more people of their calibre what a better place the world would be. This was in the week in which the lists of the richest women were published. I am always reminded that these people don’t actually make money themselves – they just acquire the money, already in circulation, from other people. What a huge contrast between the two groups. What a different world it would be if those involved in the care of older people had a bigger say in the way the world is run.

There are so many different aspects to the type of care older people need, including the importance of dental care. If people don’t have access to this and their teeth decay, then they have problems eating, and the type of foods they are able to eat. This often makes a balanced diet difficult to achieve. For people in residential care, arrangements usually have to be made not only to get an appointment with a dentist, made more difficult if they can’t afford private care, but also the transport required to take them there. There was one story of an elderly person not being able to identify her own dentures from the 3 sets in front of her. When teeth are not properly looked after it makes it more difficult for nurses caring for them.

Added to the problems associated with dental health are other areas of concern such as incontinence which I am told affects 1 in 3 older people. This figure makes it even more important that information about pelvic floor exercises, and the importance of them, be more widely known.

I am sure that as we age we don’t want to think of these issues and the fact that they may apply to us, not just other older people, regardless of who we are. We just have to be thankful that there are wonderful people who will look after us when we need it.

You would have to have a very short memory to think that change isn’t occurring all the time. It mainly happens incrementally and we are not aware of it until we look back at the way things were even a few years ago. Mainly change happens in small increments and we may not even be aware of it. If we do realise it is occurring unless it is regarded as obviously harmful to society we just let it happen.
Every now and then these small changes are not enough and we realise that major changes are needed and we need to deliberately start them.
Health seems to be one area where such changes are necessary, not just in individual situations which seem to carry their own momentum for change, but in the way we view our overall attitude towards its provision. At one time I used to get very angry because health care was disease based- tell the doctor your symptoms and he would give you a prescription to cure them. Then it was realised that the path the disease took was reliant on the patient who had it and we gradually changed to our present patient centred treatment.
Our medical world has become much more complicated as we are able to recognise, and treat, so many more illnesses and problems. So complicated that we can’t sit back and let normal evolution in treatment provision take its course. A few years ago a massive earthquake in Christchurch in New Zealand led their health care staff to realise that they were faced with a massive problem and this led to a review of their whole system. What emerged from it was the evolutionary move to patient based care in which the patient and their problems became the centre of the path to recovery. A cost analysis indicated that this would actually provide a cheaper and more successful plan for a better health system than the previous one which was proving to be ever more costly. Basically it provided a better system at a better price. This led other health systems to look at applying this new philosophy to their systems and ultimately to make the change to it themselves.
You would think that other areas that had unsatisfactory and expensive systems would be eager to look at it with a view to applying it to their own situations. Unfortunately this is where human factors come in to it. By the time people get to the top in their areas of work, particularly if it is a public service area where there is no competition in provision, they are many decades away from their early training and are comfortable with what they are doing and don’t want to change. If we add to this national leadership which can’t recognise the benefits of particular major changes, and wield a big stick to bring them about, change is almost impossible.
I believe that this is currently where many health jurisdictions are, such as in the ACT, and change is really hard to accomplish. I hope I am wrong. Otherwise people are suffering unnecessarily and costs are rising when they don’t need to.