Escape Fire

“Eat healthily, sleep well, breathe deeply, move harmoniously.” 
― Jean-Pierre Barral

As a medical student, I have learnt a thing or two first hand regarding the healthcare system and how quickly it is deteriorating especially here in the Caribbean.

The movie Escape Fire, was shown to my class earlier in the semester as a means of opening our eyes to the system specifically in America, and for us to compare it to the healthcare system locally. As a student and a previous employee of a medical institution in the United States, I find myself striving and diligently working towards a residency program there. Not because it is better per se, but because American healthcare offers the doctor the tools and technology needed in order to offer better care to patients.

Watching the movie made me realize that no matter where in the world I end up, or find myself, the field of medicine globally is in danger, as it veers towards becoming more of a business venture than a place and means of holistic healing.

It often baffles me when politicians parade in front of a camera with their views on how they plan on "fixing" the healthcare system during the election period, to only have that talk of a solution thrown out the window if in fact they are appointed the position to which they were fighting so hard for during the campaign months, and I often wonder why as a people, we tend to sit and allow the government whose purpose and position is to work for "us" the people, to get away with so much stuff, rather than holding them accountable to their so called plans for the system.

The Issues

1. Paying More, Getting Less

“The healthcare system is unsustainable. We’re spending almost twice as much in America as any other country on Earth. We’re really mortgaging the future. Not just the health of healthcare – we’re talking about the health of the nation.”- Dr. Don Berwick, Head of Medicare/Medicaid 2010-2011

In Trinidad and Tobago, healthcare is free. With this comes major issues in and of itself especially regarding transparency and accountability from physicians, nurses and healthcare administration. For services at a private health institution, one would definitely pay an 'arm and a leg' for care and sadly you aren't guaranteed any better service than what you would receive if you went to a public hospital. 

Persons are allowed to sign up for private health insurance, but with free healthcare comes a dependency by the public on the service without the desire to pay anything extra for insurance. Sadly, as Americans suffer with higher premiums and coverage for healthcare and receive nothing, locals in Trinidad and Tobago pay nothing or the bare minimum and receive nothing. 

2. Treating the Whole Person

“A great deal of what’s done in conventional medicine is to put Band- Aids on things. Or to suppress symptoms. It’s much better to try to work at a deeper level.”- Dr. Andrew Weil, Professor of Medicine and Public Health, University of Arizona

The more I read, and listen to other medical students and physicians around the world, the sad story is that they aren't afforded ample time to appropriately address and treat patients. Physicians are required to see a number of patients within a work day, which in turn leads to the overall patient-doctor relationship being destroyed and the proper treatment being given. 

Medical students are then shuffled through rotations and wards and expected to follow suite without the encouragement to elicit change in the current state. Similar to our OSCE examinations. Like, seriously, there's no way one person can efficiently perform a complete respiratory examination on a patient within 5 minutes-yet we're being taught to do it, or at least get through the anterior portion of the examination before our time runs out in order to get full marks. Why are we neglecting our customer-the patient? Why are students being taught to do the same and being reprimanded if they decide to take the time to build rapport and treat the whole person? Do you see the problem with this system?  

3. Preventing Disease

“We spend so much time in medicine mopping up the floor around the sink that’s overflowing — without also turning off the faucet.”- Dr. Dean Ornish, President, Preventive Medicine Research Institute

Preventing disease seems like a no-brainer right? Isn't it the physicians duty to educate the patient and the population on ways in which diseases can be prevented? As a medical student, and an advocate for adoption of a  healthy lifestyle, the simple education and enlightenment on prevention which believe it or not, has a lot to do with our diet is one of the cheapest advice healthcare personnel can give to the public. Often, we tend to emphasize screenings, and disease awareness, yet when a patient is sitting in front of you, and proudly broadcasting their caloric intake which mainly consists of every fatty food in the book with water being given a second thought, there are no red flags, no STOP signs being held up to even steer the conversation towards a healthier alternative. Rather a prescription pad is pulled out, a drug prescribed for the high cholesterol and we're on to the next person. 

Sometimes, I really wonder whether or not things would change if physicians were candidly filmed during their patient history taking sessions, and remedial action taken for those who merely avoid to mention ways in which disease can be prevented. 

4. Overmedication

We’ve become a culture where you drive up, you get what you want, you get it fast, you get it right away, and you drive off. And that being applied to healthcare just doesn’t work.”- Dr. Pamela Ross, Emergency Room, Charlottesville, VA

Sadly, throughout the Caribbean there seems to be a shortage of medication, so although this is a major issue faced, the chances of drugs being available as prescribed here is slim to none which poses another problem altogether. 

There is a similar culture here though, where rather than trying to prevent the disease which would eliminate the need of overmedication, people have grown to accept the fast paced life now applied to medicine that they would rather just be prescribed a drug, think about its consequences later rather than adjust their lifestyle. 

5. Overtreatment

 “Driven by perverse economic incentives, we’re doing a lot of procedures to people that they don’t need. To a man with a hammer, everything looks like a nail.”- Dr. Steven Nissen, Chairman, Cardiovascular Medicine, Cleveland Clinic 

With limited resources in the health system in the Caribbean, most Caribbean nationals are driven to find treatment abroad, mainly America. As a result, they're faced with the possibility of being overtreated possibly without knowing. Most Caribbean nationals consider "foreign" medicine to be better, probably because of the exposure to ailments and diseases, doctors elsewhere may, as well as the advanced technology in which health institutions in the Caribbean are lacking. 

The video escape fire presented the fact that for patients "more" doesn't equate to "better". And where health is related, more [treatment] can actually mean "worse". What most patients fail to realize is that they have a voice! You are entitled to adequate and effective care even if your doctor may feel otherwise. 

With that said, execute your voice to inquire on the treatment and care you require not what would probably prove beneficial. The goal to healing is getting the right kind of care, not large doses of the wrong kind. 

Photo taken from: The Emerald City Journal. Feel free to follow the link to read the article. 

6. An Entrenched System

“Our forefathers in medicine were really about patients. It was about a passion for healing, and when medicine became a business then we lost our moral compass. I think we’ve gotten into a great deal of trouble because of that.”
- Dr. Steven Nissen, Chairman, Cardiovascular Medicine, Cleveland Clinic

It's disgusting how much of a business medicine has become. Rather than seeing patients as persons coming to the hospital for healing, patients are being viewed as dollar signs. The longer healthcare is ran with a business mindset, the longer this broken system will remain in place, unchanged. 

7. Reimbursement

“When you reward physicians for doing procedures instead of talking to patients, that’s what they’re going to do--procedures.”
- Dr. Leslie Cho, Cardiologist, Cleveland Clinic

As it is now, the system rewards "higher-tech, higher cost" procedures over "lower-tech, lower cost" ones with primary care physicians not being paid as much as their specialist counterparts. With this system, the over treatment, overmedication and the quick fix system is being encouraged which leads to doing more harm than good, in that rather than working towards a healthier population, we're keeping our nation sick. 

The Solutions

1. Treat the Whole Person

This goes hand in hand with the second solution in that by treating the whole person, we would be working towards eliminating disease and improving the patients overall health. 

2. Prevent Disease and Enhance Wellness

According to the CDC, in America "roughly 75% of spending goes towards treating preventable diseases". Shocking right? Remember that saying "prevention is better than cure", well that holds some truth. 

Imagine if medical students as well as other allied health students and physicians were taught effective ways by which they can educate patients on disease prevention then that 75% of healthcare spending could be allotted to another means and maybe we could get a handle on the number of patients being treated for preventable disease. 

My initial intention for becoming a physician, was not to be a "businessman", but to learn the ways in which I can holistically assist the sick. The further into my medical education I delve, the more I find myself holding onto my reasoning for becoming a physician, and trying to be a voice of difference and change. After all, if I don't decide to stand up for what I believe to be right, pure and true, then this system will never see the desired change it is desperately in need of. My solution or escape fire, is to be that student that goes against the grain when my peers and colleagues are fighting amongst themselves to fit into a broken system. 

What's your solution to the healthcare dilemma? What's your escape fire?

Images taken from Escape Fire Movie Website.

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