Thursday, 23 October 2008

Health Consumer or Patient?

I've seen it mentioned a few times recently that the term 'health consumer' is not a good one, and that the word 'patient' is better.

Living in the UK, I had actually never heard of the term 'health consumer' until a few years ago when David Rothman suggested that I might want to consider separating MedWorm information into 'consumer health information' and 'professional information'.

I found this 'health consumer' term really quite bizarre, that a patient should be looked upon in such a manner, as some kind of business entity, yet as I came to learn more about the American health system, I understood why.

Over My Med Body! asks us to stop calling patients consumers. Nancy Turret at Edelman's Health Engagement Blog suggests that 'consumer implies consumption'.

For me, the word consumer is related to the word customer and makes me think money. The 'health consumer' buys healthcare, and the healthcare industry is ultimately focused on how to get consumers to buy their products, not how to cure the patient, or as Nancy also highlights, not how to keep the individual healthy.

In the UK the focus is different. The NHS is very much focused on cure, and the government also focusing increasingly on prevention. The words patient and individual come naturally, the term 'health consumer' is strange and uncomfortable.

I am much happier talking about patients and individuals, rather than consumers. However, I hate to say that I see the American 'health consumer' actually becoming even more of a commodity as people are almost encouraged, and often obliged (through inadequate health insurance) to cut out the middle man (the family practitioner for example), to research their own condition and make a self-diagnosis and then purchase their drugs and treatments directly, all online.

I don't imagine that the Internet and Health 2.0 is going to solve the current health care predicament in the US - it will bring about advantages, but at the same time will likely give rise to a new set of problems, and I think the term 'health consumer' will become increasingly appropriate. Of course, you could always drop the term and pretend that patients are not actually consumers, if it makes you feel better, as I think I might.

Saturday, 18 October 2008

Miscarriage for the Uninsured

What do you do when you suffering from a miscarriage, and you live in the US, but you are not covered by your insurance? Simple! Just go to bed and pretend you are having a big period.

That's what Gina from Missouri did (thanks to Meagen Bohne for highlighting such a case).

But not only is a miscarriage extremely traumatic psychologically, it can also be a very dangerous time for the woman, who has to, in effect, go through labour, and all the risks with which that is associated.

Let me tell you another story, in contrast, of a lady who was 18 weeks pregnant when she experienced a slight bleed. She called her local family practice just to make sure that it was nothing to worry about and was invited straight down to the surgery where she was given immediate attention, as a precaution. The doctor listened for a heart beat and could not find one. He showed genuine concern for the lady, although did his best to reassure her that he was not very experienced using the doppler. He called the hospital to see whether she could be given an immediate scan; the hospital told her to come straight away.

At the hospital she was treated with the utmost dignity. Since they did not want to distress the lady by leaving her to wait with the other pregnant ladies, she was taken straight to her own private room. A consultant doctor came almost immediately to give the scan, and at her side was a nurse, holding her hand the whole time to give her support. It was a complete shock for her to be told that there was no heart beat and that the baby had indeed passed away. The lady was given all the space and support that she needed at this emotional time, was brought a cup of tea and was then consulted regarding the options on how best to deliver the baby. After discussing the pros and cons of the different options in as much detail as she wished, she decided to deliver the baby by natural methods with the help of a tablet that would turn off the pregnancy hormones. She was able to decide when would be the best time for her, and when she returned to the hospital later that evening to begin the process again she was treated with great care and sensitivity.

Even though she had to deliver in the labour suite she was given her own private room from start to finish and she was never confronted with having to face any of the other pregnant ladies or babies that had been delivered successfully. She was given the exact same attention as if she had been delivering a live baby, with a midwife to attend to her personally from start to finish and regular visits from the doctors. The midwife was able to answer all of her concerns and helped to mentally prepare the lady for the actual event.

Before the baby was delivered she was consulted as to how exactly she would like the events to proceed, every step of the way, and was given time to hold the baby for as long as she wished. After the process was complete, in her own time, she was consulted on what she would like the hospital to do with the body, and given booklets explaining her options. The lady had a personal point of contact to help her through the process in the coming weeks, which included an autopsy of the baby and genetic testing in accordance with her wishes, as well as liaising with the hospital and undertakers to arrange for a burial in the local cemetery, in an area specially allocated to babies that die in the womb. She was also given aftercare, from a community midwife who called at her house, by the local doctor to ensure that she made a good recovery in the following months, and a visit back to the hospital to discuss everything including the autopsy results with the OBGYN consultant doctor.

The whole event of loosing your unborn child can be psychologically very painful and can carry many of the same risks as delivering a live baby. This hospital did everything it could possibly do to help keep the pain, and risks, to a minimum, and provided follow-up care to ensure a good recovery, and testing to see if there was anything that could be done to prevent a recurrence of the miscarriage in the future. They made what was a very difficult event somewhat easier to bare.

And the cost of the the whole treatment from start to finish, including the autopsy, genetic testing and burial? Well, nothing actually, at least not directly to the lady, since everything was paid for by the NHS.

Friday, 17 October 2008

Investment in Generosity - A Solution for the Uninsured?

In the run up to the US elections (your politics I have to admit are so much more fun to watch than ours in the UK), let me suggest, from an outsiders viewpoint, that you might all like to consider the mess you have got yourselves into with your health care, or rather lack of it.

I know you know this, and honestly the problem is so huge I have no suggestions, other than one major revolution. But just in case you can't see the wood for the trees, thought I'd take the time to remind you guys that there is a lot unnecessary suffering going on over there, probably going to get a lot worse before it gets any better, due to lack of insurance, underinsurance, and problems getting paid even when you do have the right insurance.

The Cover America Tour is a great project that puts some human faces on to all that suffering.

Makes me angry you know, and it's not even my country. If I were you, I think I'd be on the streets shouting. The situation simply isn't acceptable in the developed world. Problem is, the time when it will really matter to you personally, you'll probably be too ill or too weak to make a loud noise about the injustice. How many people in good health, with a job that includes good health insurance, are prepared to make a fuss and vote to pay higher taxes to give better provision to those in less fortunate circumstances?

If you do have a good job, imagine what life will be like if you loose it and your insurance - can happen to anyone, as you are currently well aware. Maybe selfishness with some foresight might lead to a better solution, if consideration for others is not enough? You pay for insurance to protect you against misfortune, yet insurance alone is often not enough when real misfortune strikes - and in those cases you will be dependent on the generosity of society. It is your generosity during a time of strength that will provide you with real insurance the day that you fall. Maybe generosity, consideration for the less fortunate, is something that you would invest in, if you could understand its benefits to you in the future?

Here's a MedWorm news feed for the uninsured.

Wednesday, 8 October 2008

Searchme Searches MedWorm

I came across searchme yesterday when looking through MedWorm's stats. Like many webmasters these days I have to keep a constant check on what robots are trawling on my site - many I have to block since they only have a basic understanding of my robots.txt file and insist on trawling all the pages I don't want them to, using up way too much bandwidth and processing power for the amount of traffic that they actually bring back to MedWorm. Since I do not big financial backing for endless upgrades just yet, I have to ensure that I get maximum use out of my few resources, so have to act a little ruthlessly when it comes to dealing with inconsiderate robots.

Searchme caught my attention since it appeared a little 'aggressive' in its approach, and I was actually considering putting it on to my blacklist, but fortunately decided to check out their site first - and what a surprise! I know that everyone is constantly looking for the next big thing, an alternative to Google (which of course I will tell you is MedWorm for the medical sector), but not often am I sufficiently impressed enough with a site to really think that it will go far. But this time, I am; I think searchme brings a new approach to the Internet that will indeed go far.

I found it extremely useful in quickly finding out what other sites are doing with MedWorm feeds, and to complile a list of MedWorm recommendations from what people are saying in the blogs. From my search, I was able to create a new 'stack' of MedWorm recommendations from the blogs. Check it out:

Tip: Normally I would never dream of recommending something like this, but I think it worth pointing out, for medical purposes, that if you change in your preferences not to filter content, you do get returned many more results - I tried this since I wanted to be certain that MedWorm content is not appearing on any 'unsavoury' websites (and was relieved to find that it doesn't appear to be), but in doing so I found many more records returned from excellent websites. I guess due to the medical nature of a lot of sites that MedWorm appears on, lots of those sites are thought to possibly contain some adult content.