I keep hearing all this talk about how the emphasis in medicine needs to be on prevention of disease, and not disease management or cures. As a nurse with over 20 years experience in a variety of clinical and business settings, most recently in mental health, I would like to suggest the new paradigm of prevention first is a bit mis-guided and unrealistic.
First, what is prevention? How do you realistically "prevent" obesity, high blood pressure, diabetes, heart disease? There are only 2 ways to affect these chronic diseases: education or dictate. The health community has focused on education for 40 years. Constant repetition on message has slowly changed the numbers of unintended pregnancy, smoking, STDs, and AIDS related illness. There are other examples too, but changing behavior is a slow process. Education alone does not prevent chronic medical problems, at least not quickly.
So the new health reform thinks they can prevent first, limit the expensive care to a few choices at the end of life, and suddenly every one in this country will have excellent universal care that is cost effective, paid for, and even reduce the deficit. Only one problem: you can't dictate behavior.
This is the only way large scale changes could lead to the kind of Utopia one side of the spectrum is envisioning for this county. If you punish behavior that causes chronic disease, it is the only way to effect change rapidly. So, your freedom to choose is taken away, "for your own good" because people left to their own devices will not make smart choices. Outlaw transfats, outlaw tobacco (so why is it still legal if you really want people to quit smoking?) Outlaw sugar, outlaw meat (global warming), remove all snacks except fruit and vegetables from the school vending machines, tax complex carbs to reduce useage, mandate 1 hour of exercise daily for all citizens, fines for BMI over 30, fine smokers. I know - maybe you could just remove food and use compressed supplements with all the recommended nutrition. And those weak humans to do develop diabetes, or high blood pressure, or have too much fat? What do we do with them, after all our "help" controlling their weakness?
Maybe it is time to re-read Brave New World, Farenheit 451, Animal Farm, and Soylent Green. As for me, I prefer the education route, and continue to fund research in to cures. This may be a bit tongue-in-cheek, but this pie in the sky talk about prevention, not cure or treatment of disease seems to ignore the human factor and the gift of free will. I don't want government to take that away from me. Positive reinforcement has always worked better to change behavior than punishment, and yet in this new world of reform, the only way to prevent disease is to punish the behavior that causes it.
in canada, where i grew up, we used our "sun porch" for frozen foods. if it got sunny (seldom in winter), we'd take meat and fish to a "locker", a business that just stored frozen foods for people. that was a half hour walk to it, and longer when we had heavy frozen food to carry.
honey, i'm much older than you - we had "ice boxes" instead of refrigerators, and horse drawn carriers for the ice blocks separated with sawdust, that kept them (the ice boxes) cold. the top of the milk, in a rounded glass part, was our ice cream, which we weren't allowed a bit of, without permission. it was worth that treat, to drink the nonfat milk left, after the cream had been consumed.
i live in ca in the summer, and virginia in the winter (i hate their hot, humid summers), having split the ca house i sold, into 2 condos after my daughter in va was diagnosed with ms. my son is in ca.
you better change your bio here then cuz i've got 10 years on you. this ain't canada. we still get milk delivered to our homes in maine. we used to walk to school in 40 degree below zero weather. up hill both ways.
i drank whole milk all my childhood. milk i milked from the cows before going to school. cows we fed silage to in the winter made from foder corn.
I have noticed something in these threads which gives me pause...
We banter about our personal responsibility for premiums, and planning, and even for preventative care. The elephant in the room is that much of the human health concern cannot be planned for, and is largely unpreventable (when you rule out vaccine preventable disease and famine). Most cancers...only a few have known causes...we speculate a lot. AV malformations or disorders. Congenital cardiac defects...etc. You get my point. There are scores of people in all walks of life who will never be able to adequately prepare for the financial strain that life will throw their way...they have no control over it. Throw in mid-level things that are still expensive (with high deduct/copay policies) like broken bones, appendectomies, blown knees, etc; and the working poor family is destitute.
I am ready for us to radically change the way we view healthcare in America. I wish our politicians were not the ones writing the laws regarding such change.
Your last 2 sentences could come right out of my mouth. And yet you want to disagree with me.
Large facilities have similar costs for older employees. I lost 8 good positions after I was 55, at a Public Health Department's clinic; a hospital's patient education department; a large "foundation"; and the last one was Blue cross/Wellpoint. That was like being in the den of tye enemy! They made me fill out the health insurance questionnaire that has a space for your birth date, and I didn't fill that in (I'd told them that I already had health insurance from another source). It was sent back to my supervisor who asked that I fill it in (nicely, she thought I'd forgotten); and then I was called by 6 different individuals from different departments there, asking what my birth date was (somewhat illegal). I was told to go to another building several miles away from the one in which I worked, where the security department is (couldn't they have sent it by interdepartmental mail?), to write my birth date under each picture of me (I don't look/act my age of 70) that they had taken. The next day I was told I "wasn't a fit", and was asked to write a letter of termination (???). I wrote a letter saying what had happened, and was escorted out with all the stuff I'd brought for my use and comfort in the tiny cubicle to which I'd been assigned. So I gave up on paid work.
Are you 48 as your bio here says or are you 55 as you state in this post? Or are you 70? It's hard to tell.
Specializes in Critical Care, Insurance Case Management.
don't confuse "room for improvement" with bad!
i said what i meant to say.
i remember your posts now - you remind me of many of the workers comp cases i worked with who had a litany of woes about how they were discrimated against and how nothing was their fault. i always found if you did a good job and didn't complain at work, there was no reason to fire you other than layoffs. it doesn't matter what age you are. i have worked with floor nurses who were 70. it would seem if you are 65 that makes you eligible for medicare, doesn't it. the medigap supplemental is about $96 a month; perhaps you were not encouraged to be on a full ride health plan since you should have had medicare primary?
i worked at henry ford hospital in detroit, and the hospitals had plenty of canadians, both to work and as patients. if the canada system is soo great, why did so many nurses cross the border with their tim horton coffees in hand to work everyday?
this story you have repeated many times on this forum of being marched off the job site for not admitting to your age smells of missing details. sorry.
and, i worked at bcbs of michigan in southfield. well point is different, and has a poor reputation as a profit driven company.
Specializes in Critical Care, Insurance Case Management.
absolutely not!!
when a person becomes seriously ill, and can no longer work effectively due to that, they pay little to no taxes, need health care programs paid by taxpayers, and generally become entities that make them liabilities, not assets. they haven't enough money to pay for one hospitalization or monthly premium (especially if that is adjusted upward according to increased need for health care).
that's what this heartless, selfish society has created.
i figured it out - this is all about you, isn't it? you mentioned you got stress ulcers not caused by h. pylori; doesn't happen by the way; that has been debunked. stress alone without anything else going on doesn't=ulcers.
they've seen how it is in the us, and pity me for being here (which i wouldn't be, where it not for my grown children and their children, who i like to see) so let your kids get a passport and visit you in canada - i hate the idea you are pitied for living here.
medicare allowed that! but many americans resent its presence. i don't know anyone who resents medicare, other than the current administration who has made it clear that those elderly americans use the most at the end of their life, and therefore should be controlled better to reduce expenses - your friend obama and co
or would you rather i had died of my illness (gastric ulcer caused hemorrhages that have no bacterial etiology, just stress) and saved you some money? or that i went to a facility where you wouldn't have to see me, but would cost our government far more, than care at home? look up the life expectancy of those housed in those facilities what is heavens name are you talking about? we do not have institutions where they lock you away, never to be seen again with death everywhere. even in the rural county i live in, the skilled nursing facilities are clean, caring, and most follow the eden concept of home environments. you have been out of it too long, and you certainly haven't been in one of those "facilities" lately. things have changed in the past 15 years. ok, enough of this - i have degenerated into off topic stuff just like others have. easy to do i guess. we are looking for solutions to concerns, not bi*** about the u.s. i like it here, and i have always taken care of myself, taken hits and recovered in new ways, and made sure i had an education, a job, and health insurance. and not one dime has come from the government! i am also trying to stop them from taking 50% of my paycheck for taxes.
we promote the idea of lively debate. this means you are free to disagree with anyone on any type of subject matter as long as your criticism is constructive and polite
please remember to debate ideas and not personalize/marginalize others contributions.
"........Don't you find it interesting that the media is encouraging people to wash their hands to avoid the spread of the flu. Do we really need to remind adults to wash their hands? Do they not know that there are germs on their hands?"
If you go to public restrooms (especially men's rooms - sorry, guys), you'll see why adults must be told to wash their hands, WITH SOAP. It'a like, hey, this means you!! I'm always tempted when I see the signs in wash rooms, to write "WITH SOAP" under the wash hands notice. It takes a lot of parenting direction to make something a habit. Carrying waterless soap helps, as many people don't want to take the time before eating, to go to a rest room and do the usual thing, and then open the door usinf a paper towel, as the germs from those who didn't wash their hands after elimination, are still there.
Having taught prenatal classes, stop smoking classes, breastfeeding and parenting classes for 35 years, as well as breast self examination to discover early breast cancer, I'd like to share a few things I've learned about education and people. First of all, it is possible to educate adults, who may seem impervious to change, but when they're facing childbirth for the first time, scared to bits about the pain, and things people have told them that seem disgusting, it's important to acknowledge where they are, by LISTENING TO THEM. So at the first class they are asked to say what they want to learn, specifically. The variety of responses is exciting and they're usually different.
Students aren't used to a teacher who listens, so that has shock value and novelty, getting their attention. Usually everything that is covered in the series of classes gets touched upon that first night, and whets their appetite to hear/learn more. When there's resistance to a part of the information (like dietary changes), and there's alkways some of that, it's important to "hook" students by reminding them of what it was they said that first night, that they want from the "learning shop" they're in.
Mutual respect and repetition are the clinchers for teaching/learning. The teacher needs to mention things students do well, showing respect for them (and there's always something there); and students need to know that the teacher knows his/her stuff and will get them through with all the learning they need, in the time allotted. Just btelling someone you have a degree, conferring expertise in a subject, won't get respect. They know that force feeding information and regurgitation of facts = learning. The application of learning is what they came to get! I've heard floor nurses say, "Well, I told her/him what would happen if............" You have to say it, then say it again, then say it again, until demonstration of retention is there, if you really want learning to occur. That's human nature, not condescention. So commitment is necessary from both sides.
When I saw in a post that no one learns anything that creates change in what they do, it made me want to say, you get what you put into it. When the teacher involves him/herself in the material, and when the student is ready (which is absolutely necessary and needs to be set up by the teacher), miracles happen. I'm fond of telling prenatal students that they'll get out of the classes exactly what they put into them. Less input, less reward.
Why do you think that some school teachers pay for their own teaching aids, special visual effects, spend time beyong their employer's wildest dreams and care so much that they give to students all they have (if they're to teaching born). Their payoff is the evolvement of minds that they've filled with information that is valued by the student (you can tell, even if they don't show that). What I want from students in my classes, is not perfect techniques, but a sense that labor can bring on what it will, they can cope!
Prevention of extended complications is also a goal of childbirth preparation, so cause and effect needs to be understood and employed. Put salt on your food, you'll get swollen legs is realised easily. The fact that swollen extremities, face, etc. is a sign that means they need to be seen by a doctor that day or night or suffer serious consequences, needs emphasis which usually results in compliance. Fear is necessary for change, whatever it is that needs changing. So the threat of danger needs to be emphasized, too.
That is never more true than with women regarding breast cancer. If they didn't fear a long, painful illness ending in their death, they wouldn't regularly examine their breasts at a special time of the month before menopause, in two different positions and visually at the mirror. They can find a breast change, and that means they have to bring their observation to the doctor, not letting an appointment scheduler put them off for 6 weeks or however long it takes to be on the schedule of the doctor they need. It can take perseverence to overcome obstacles to early diagnosis, and (not "but") it can be done!!
I must have convinced myself of that when I discovered a small, pea sized lump in my left breast, 36 years ago. It was Columbus Day and few doctors were in their offices, so I called a student who was a surgeon and taking my classes nat that time. He heard the panic in my voice and said he'd meet me at his office in 2 hours, mentioning that I was too young for breast cancer. What neither of us knew then (and researchers discovered later),is that descendants of women who had breast cancer, get it earlier in life, which I did. Early diagnosis worked for me then, and again in 4 years (1978). I always say that I'm glad I was given only 2 breasts, and there was no lymph node involvement. Mamography was new in 1978, and they didn't find the mass upon doing that study. I knew however, that neither lump had been there when I examined myself a month earlier, which was some consolation.
What I've done here, is deviate a bit from our subject of this thread, and it examplifies the result of learning for prevention of disease.
So I hope I've loosened your hold on the sense you've expressed that education for prevention of things that can make a disease process worse isn't possible; and has resulted in some change of that stance. Once a disease is there, is when the start of learning must occur, to lessen its hold on patients. Most diseases can't be prevented, until their impact makes people know that they're really going to suffer if they don't change their habits. Then they need to know the road to success and follow it.
If you go to public restrooms (especially men's rooms - sorry, guys), you'll see why adults must be told to wash their hands, WITH SOAP. It'a like, hey, this means you!! I'm always tempted when I see the signs in wash rooms, to write "WITH SOAP" under the wash hands notice. It takes a lot of parenting direction to make something a habit. Carrying waterless soap helps, as many people don't want to take the time before eating, to go to a rest room and do the usual thing, and then open the door usinf a paper towel, as the germs from those who didn't wash their hands after elimination, are still there.
Having taught prenatal classes, stop smoking classes, breastfeeding and parenting classes for 35 years, as well as breast self examination to discover early breast cancer, I'd like to share a few things I've learned about education and people. First of all, it is possible to educate adults, who may seem impervious to change, but when they're facing childbirth for the first time, scared to bits about the pain, and things people have told them that seem disgusting, it's important to acknowledge where they are, by LISTENING TO THEM. So at the first class they are asked to say what they want to learn, specifically. The variety of responses is exciting and they're usually different.
Students aren't used to a teacher who listens, so that has shock value and novelty, getting their attention. Usually everything that is covered in the series of classes gets touched upon that first night, and whets their appetite to hear/learn more. When there's resistance to a part of the information (like dietary changes), and there's alkways some of that, it's important to "hook" students by reminding them of what it was they said that first night, that they want from the "learning shop" they're in.
Mutual respect and repetition are the clinchers for teaching/learning. The teacher needs to mention things students do well, showing respect for them (and there's always something there); and students need to know that the teacher knows his/her stuff and will get them through with all the learning they need, in the time allotted. Just btelling someone you have a degree, conferring expertise in a subject, won't get respect. They know that force feeding information and regurgitation of facts = learning. The application of learning is what they came to get! I've heard floor nurses say, "Well, I told her/him what would happen if............" You have to say it, then say it again, then say it again, until demonstration of retention is there, if you really want learning to occur. That's human nature, not condescention. So commitment is necessary from both sides.
When I saw in a post that no one learns anything that creates change in what they do, it made me want to say, you get what you put into it. When the teacher involves him/herself in the material, and when the student is ready (which is absolutely necessary and needs to be set up by the teacher), miracles happen. I'm fond of telling prenatal students that they'll get out of the classes exactly what they put into them. Less input, less reward.
Why do you think that some school teachers pay for their own teaching aids, special visual effects, spend time beyong their employer's wildest dreams and care so much that they give to students all they have (if they're to teaching born). Their payoff is the evolvement of minds that they've filled with information that is valued by the student (you can tell, even if they don't show that). What I want from students in my classes, is not perfect techniques, but a sense that labor can bring on what it will, they can cope!
Prevention of extended complications is also a goal of childbirth preparation, so cause and effect needs to be understood and employed. Put salt on your food, you'll get swollen legs is realised easily. The fact that swollen extremities, face, etc. is a sign that means they need to be seen by a doctor that day or night or suffer serious consequences, needs emphasis which usually results in compliance. Fear is necessary for change, whatever it is that needs changing. So the threat of danger needs to be emphasized, too.
That is never more true than with women regarding breast cancer. If they didn't fear a long, painful illness ending in their death, they wouldn't regularly examine their breasts at a special time of the month before menopause, in two different positions and visually at the mirror. They can find a breast change, and that means they have to bring their observation to the doctor, not letting an appointment scheduler put them off for 6 weeks or however long it takes to be on the schedule of the doctor they need. It can take perseverence to overcome obstacles to early diagnosis, and (not "but") it can be done!!
I must have convinced myself of that when I discovered a small, pea sized lump in my left breast, 36 years ago. It was Columbus Day and few doctors were in their offices, so I called a student who was a surgeon and taking my classes nat that time. He heard the panic in my voice and said he'd meet me at his office in 2 hours, mentioning that I was too young for breast cancer. What neither of us knew then (and researchers discovered later),is that descendants of women who had breast cancer, get it earlier in life, which I did. Early diagnosis worked for me then, and again in 4 years (1978). I always say that I'm glad I was given only 2 breasts, and there was no lymph node involvement. Mamography was new in 1978, and they didn't find the mass upon doing that study. I knew however, that neither lump had been there when I examined myself a month earlier, which was some consolation.
What I've done here, is deviate a bit from our subject of this thread, and it examplifies the result of learning for prevention of disease.
So I hope I've loosened your hold on the sense you've expressed that education for prevention of things that can make a disease process worse isn't possible; and has resulted in some change of that stance. Once a disease is there, is when the start of learning must occur, to lessen its hold on patients. Most diseases can't be prevented, until their impact makes people know that they're really going to suffer if they don't change their habits. Then they need to know the road to success and follow it.
Women are still having babies without any education. It's a natural process. I didn't know that pregnancy is a chronic illness or a disease.
I work with ESRD patients. You can tell them 156 times a year not to drink so much and show them boggy hearts and they will still gain too much weight.
women are still having babies without any education. it's a natural process. i didn't know that pregnancy is a chronic illness or a disease.
oranges
i work with esrd patients. you can tell them 156 times a year not to drink so much and show them boggy hearts and they will still gain too much weight.[/quote
there are also lay "nurses" without any education, who can do more harm, than good....... m.a.s who call themselves nurses; and straight off the street care "technicians", etc.
you're right about one thing, sweetie onekidney, that uncomplicated childbirth isn't usually chronic (unless a yen for children by the dozen occurs), or a disease. what needs to happen, is preventive teaching about family planning; and recognition of signs/symptoms of disease (eclampsia) or complications (abruptio placenta) are recognized, to get medical care soon enough to save their lives. if women want/choose to give birth as cavepeople did, with no knowledge even, of how that watermelon got into their stomach, all they'll know is that pain signals a need to get to safety - back to the cave when in labor. that's a function of pain! (my apologies to the neanderthal looking characters in geico tv ads)
esrd patients are a whole other matter. they usually know the end is near, and while their conscience may not embrace thoughts of suicide, yielding to thirst when they've been told that will bring on death sooner, may be something like that.
i cared for a woman in esrd at her home for many months, doing private duty, years ago. she wanted life, for many years, having been on dialysis for at least a decade, until it just became too onerous. yet her family and doctor kept insisting that she deprive herself of the things that meant comfort to her. when she asked for the denied foods, drink, etc. i told her that it was her choice, at the end. yet she didn't want to betray her husband and risk the blame of causing her own death. she was not diabetic, but had malfunctioning kidneys due to frequent untreated utis that progressed to nephritis to acute pyelonephritis. had she been educated regarding s/s of uti, she may have had early treatment and still be alive and well, today.
women are still having babies without any education. it's a natural process. i didn't know that pregnancy is a chronic illness or a disease.
oranges
i work with esrd patients. you can tell them 156 times a year not to drink so much and show them boggy hearts and they will still gain too much weight.[/quote
there are also lay "nurses" without any education, who can do more harm, than good....... m.a.s who call themselves nurses; and straight off the street care "technicians", etc.
you're right about one thing, sweetie onekidney, that uncomplicated childbirth isn't usually chronic (unless a yen for children by the dozen occurs), or a disease. what needs to happen, is preventive teaching about family planning; and recognition of signs/symptoms of disease (eclampsia) or complications (abruptio placenta) are recognized, to get medical care soon enough to save their lives. if women want/choose to give birth as cavepeople did, with no knowledge even, of how that watermelon got into their stomach, all they'll know is that pain signals a need to get to safety - back to the cave when in labor. that's a function of pain! (my apologies to the neanderthal looking characters in geico tv ads)
esrd patients are a whole other matter. they usually know the end is near, and while their conscience may not embrace thoughts of suicide, yielding to thirst when they've been told that will bring on death sooner, may be something like that.
i cared for a woman in esrd at her home for many months, doing private duty, years ago. she wanted life, for many years, having been on dialysis for at least a decade, until it just became too onerous. yet her family and doctor kept insisting that she deprive herself of the things that meant comfort to her. when she asked for the denied foods, drink, etc. i told her that it was her choice, at the end. yet she didn't want to betray her husband and risk the blame of causing her own death. she was not diabetic, but had malfunctioning kidneys due to frequent untreated utis that progressed to nephritis to acute pyelonephritis. had she been educated regarding s/s of uti, she may have had early treatment and still be alive and well, today.
21 year old esrd patients are not near the end. in 2002 gambro previewed a gentleman who had been on hd for 30 years. that meant he started in the dark ages of hd. 1972 we had just stopped using wash tubs.
Specializes in Critical care, tele, Medical-Surgical.
Ok I'll help you with your confusion. You are actually answering 2 different posters. I got that you didn't get my reply. When someone spouts a view here I don't necessarily believe their source. I tend to look for my own sources. Many don't realize that the insurance companies are behind this whole thing. They'd love to have 47 Million new customers. And another thread here chats up that fact.
Insurance companies aren't going any where anytime soon. They are a $$$$ making entity for more than their CEO's. Many are heavily invested in BIG Pharma and insurance companies and they don't even know it.
Onekidneynurse
475 Posts
you better change your bio here then cuz i've got 10 years on you. this ain't canada. we still get milk delivered to our homes in maine. we used to walk to school in 40 degree below zero weather. up hill both ways.
i drank whole milk all my childhood. milk i milked from the cows before going to school. cows we fed silage to in the winter made from foder corn.