True Healthcare Reform

I was recently thinking about one of my patients—someone who doesn’t seem to want to get better or be healthy—a patient with multiple chronic problems that are not well controlled. A patient like this one seems to have no motivation to make any changes. As his nurse practitioner, I see this patient’s health going downhill, and realize that a little exercise, some dietary changes, quitting smoking, and other lifestyle changes or attitude changes could make a huge difference. But the patient seems indifferent. He makes excuses, he provides rationalizations and, although his metabolic parameters are significantly worse, he says that he feels fine and doesn’t want to do much. He may be willing to add another medication or two or do a few tests here and there, because now he is experiencing some chronic complications of his conditions. But he makes little movement toward substantial or lasting change. It all seems so pointless—so ineffective, so inefficient, and not at all cost effective. Caring for this patient is discouraging for me personally, and a drain on the healthcare system as a whole. As I thought about this patient, I was reminded of what is happening to the country itself in terms of healthcare reform.

We have a healthcare system in this country that has multiple chronic problems that are not well controlled. We watch the system as it goes downhill. More and more people are becoming overweight or obese, failing to remain active, and losing whatever health insurance they had, if they ever had insurance at all. Markers of individual and overall health in this country are declining. Most of the industrialized world is doing better at health care and on health quality, and for far less money. Health care has been the talk of the town—and the nation—for the past year. Up until last month (ie, March 2010), we wondered if our government would pass any bills effectuating changes in the healthcare system. Even though the existing healthcare system has been so ineffective, inefficient, and expensive, we heard mostly excuses and rationalizations from those opposing healthcare reform.

And now, many people are expressing fears about what will happen in our country with the recently passed healthcare legislation. Many people are still saying that the “patient” is “fine,” and that there is no need for change. Yet the “metabolic” indicators clearly show problems with the current healthcare system in this country. Without interventions, without some type of change, the country, like my patient, will experience chronic complications and poor health outcomes at increased cost. What we have seen is a change—likely the first of many to come—but most important, a change in the status quo that we know hasn’t been working.

We must not sit idly by, waiting to see what this new legislation will produce. Healthcare reform goes far beyond what can be accomplished through legislation. For example, a patient came into my office the other day. We have been working together for several years. He had lost 48 pounds in the past 18 months! He had a history of pre-hypertension, pre-diabetes, and hyperlipidemia. At this visit, his blood pressure, lipid values, and HbA1c were all normal! He had instituted lifestyle changes that truly made a difference in his health now, and for the future! I affirmed his changes and worked with him to plan on his continued weight loss. “This is healthcare reform at its best!” I told him. He didn’t reform the delivery; he reformed his attitudes and his lifestyle. He will save the healthcare system thoursands of dollars. His weight loss has normalized his metabolic parameters without medications, without co-pays, and without the chronic complications these same poorly controlled conditions would likely have caused in the future. Maybe healthcare reform, at the political level, needs to include rewarding positive, health-promoting lifestyle changes.

We can’t legislate weight loss, smoking cessation, and healthful lifestyles. It’s up to patients, and it’s up to us. True, there can and should be changes made in the healthcare delivery system that improve access to care (and payment for care), ensure quality of care and reduce the costs of care, and maybe even some changes that foster and even reward healthful living. But each day, no matter what legislation is passed, we and our patients can be the faces of healthcare reform. As NPs, it’s what we do best—providing efficient, top-quality health care. Most of all, we must affirm the lifestyle changes our patients make. We must cheer them along and let them know that their health-promoting lifestyle changes are healthcare reform in action! As more of us live this healthcare reform on a day-to-day basis, we will likely see change in the healthcare delivery system in this country, at least movement in the right direction. My patient didn’t suddenly lose 48 pounds. It didn’t take only 18 months. We worked together for years on education and motivation before our efforts started bearing fruit. Just as lasting change comes slowly with an individual patient, I believe that, with the influence of NPs, lasting change will slowly occur at the national level. NPs and our individual patients are the real hope in healthcare reform!

Read recent letters from our readers to Tom Bartol, NP