In Response to the Big Med

Can health care be managed in a way that combines quality control, cost control, and innovation?  With the presidential elections around the corner and the advent of the ACA, the question has never been more acute than now. Public health-care reform is sought to reshape the system with the goal to reduce cost and provide quality care for the population. Along comes the difference in opinions on the ways how re-structuring of the health care should be accomplished to decrease soaring costs and at times mediocre or unreliable services. According to some, we should take a look at the restaurant business and adopt their deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality.

The idea to adopt a restaurant business model can raise an eyebrow or a mocking laugh in some, while it can seem appealing to others. Children of consumerisms, Americans expect quick, cheap, and reliable services. In a restaurant, every dish involves deviation from a set recipe and attention to detail for personal adjustments. We expect the restaurant chains, like Cheesecake Factory, manage to accomplish consistent quality results over and over again across the entire country. Similarly to the pager beeping that informs you about the table becoming available, we expect the emergency room staff to inform us about the time it is going to take to be seen by a physician, or the cardiac surgeon implanting the exact high-quality valve in the heart of our loved one as he did for some high-profile executive three surgeries ago.
I admit, I initially scoffed on the idea of adopt a restaurant business model to the health care, thinking, “Who is this person comparing intricacies of illnesses and individual health factors to the restaurant dishes?” Intrigued, I kept reading and found out that the author is a pretty much a colleague of mine who works in another hospital in the city and has not lost touch with reality. Sharing a personal experience in health care affirmed the thought that there is truth in what is said. Some patients chose a physician who has titles and titles after his name, but then they have to rely on doctors who may have insufficient information or economic incentives to pick the costliest treatment.
There are two sides to the coin. I think it is our duty as health care professionals to be informed about the best evidence regarding treatment options, and either to follow the best standards or to develop new standards. If the evidence shows that prescribing a blood-thinning medicine during the hospital stay prevents the formation of blood clots caused by decreased mobility, then it is only common sense to prescribe it to the qualified patients (note to deviate from a set recipe for contra-indications). Fewer blood clots leads ultimately to better patient recovery and lower hospital bill. Adhering to the best-researched evidence can after all allow the providers to deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality.

The other side comes from the financial aspect of healthcare, ethical concerns, time that it takes to prove the effectiveness of certain interventions, and the nature of healthcare settings. Changes in healthcare seem to be harder to implement than in other customer-oriented areas. For example, I almost want to bet on the fact that it is easier to approve a new dish for a menu in a Cheesecake Factory at the Prudential than it is to implement the use of LUCAS chest compression system in a near-by BIDMC Emergency Room with well-trained, qualified personnel. Another example is treating a patient for pneumonia according to an algorithm that has been proven to be effective: one adhere to the best standard ever yet not to achieve the same result due to unforeseen factors like co-existing illnesses, constantly mutating microbes, religious beliefs against blood products, unnecessary tests the patient demands because “I read it on-line”, and what not. I am not saying that delivering quality care is an un-achievable goal in healthcare, I simply b

Read more: Atul Gawande: Big Med…Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care?

http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande#ixzz27V3AdyYM

Body Image and Self-Esteem in High School Students

 I am too fat. I am too skinny. My butt is too big. My hair is too curly. Does any of this sound familiar? To me, these statements help define the issues that the teenage girls have to deal with, the emotions that come along, the behavior that results from the issues and emotions. So this week’s post is devoted to the health behavior as it relates to the body image in teens.
During one of my first visits to a high school somewhere in the United States, I took a tour of the school to familiarize myself with the surroundings in case we get called into one of the buildings for an emergency. When I was walking in the health education section of one of the buildings, my gaze got drawn to a very colorful board made up of clippings from what looked like students’ essays. I came closer, and here is w hat I saw:

  The board was a collection of the thoughts on body image. At the beginning of the semester, one of the health education teachers made up a collage that reflected the feelings the students experienced regarding their body image. She kept the postings anonymous, and displayed the collection on the wall to make the rest of the students realize they were not the only ones to go through changes that affected their body and their self-esteem.
 

 
 
 
 
 
 
 
 
 
 
 
 
 A few weeks later, I was lucky to visit this teacher’s health education class, and I was even luckier to visit it during the time, when body image and disordered eating were discussed with the students. Part of the homework for the class was to visit the board that I mentioned earlier and to make observations about it. I was amazed by the feedback that the students provided about the postings, the students’ comments were very insightful and mature for the age. Here is what I heard:
“All [the postings] were about physical things”
“I can relate to some of them”
“I noticed that some of those things you could change by exercising, or eating right. Other things, you could change my dying your hair, or dressing in different clothes. But doing so can change who you truly are”
“A lot of the postings were about weight. I noticed that it was about what [the students imagined] people thought about you and your body”
“I think about my body image all the time; you can’t escape it, it is everywhere: it is in the mirror, in the movies, and your friends talk about the looks”
The issue of body image and self-esteem is very important during the high school years. Body image is how people feel about their own physical appearance, while self-esteem is about how much people value themselves. Self-esteem is important because feeling good or bad can affect how people act. This is where theories of health behavior may provide some information about why people feel a certain way about themselves, and why people act a certain way. These answers may be useful to the nurses so that they can provide better care. For example, a problem of body image and self-esteem can be viewed from the macroscopic approach of conceptualization of the health problem (Yes, I do think that body image is a community health problem, because it leads to multiple problems including eating disorders, cutting, and suicide). According to this model, the individual, here a teenager, is in the middle, the center contains the problem of interest: inadequate self-esteem based on the distorted body image. In this context, interventions would focus on individual high school students, or a small group of students with this problem.
The rest of the class time was built according to the principle of microscopic approach; the teacher incorporated various activities to examine the students’ attitudes to body image, to examine the prevalence of distorted body image, to locate the sources of influences, and to introduce ways the students can optimize coping with the developmental changes occurring to their bodies as well as mental issues that accompany these changes. She explained that the student struggle with the issue of self-esteem at this vulnerable age, because puberty causes changes in the body. By asking the class respond to how they felt about other people criticizing the way they looked, she examined the sources of influences. Since all the activities were conducted in a very informal manner, and the students could move freely in the classroom, they felt more comfortable expressing their feelings.
I think that this class taught me about the ways to talk to the girls if they come to the nurses’ office to discuss body-image issues, help me find ways to examine causes of disordered eating, and allow me find strategies to make these girls feel like they are not the only ones, that there are things they can do, and that after all, there is a person they can trust and always talk to.