"Hopelessness" and Facilitation....

Dr Ed Leap, a well respected blogger, and author that I respect, recently posted his blog on "Hopelessness". I read through it and it was quite thought provoking.

The main point I believe Dr Leap was explaining, was that no matter how much logic, observation, rationalization or coercion we use/do - there are just some aspects of human behavior that cannot be adequately explained with the traditional models we, in healthcare, use.

His conclusion was that people will continue self-destructive behaviors, not through any particular rational process, but from a state of hoplelessness; when there is no perceived better alternative, benefit of change or motivation to do same.

In the frame of reference of the people we deal with on a daily basis in the ED setting - I can testify to this; but that is because of what they come to see us for: afflictions of mind, body or psyche.

And yes, as I agree with Dr Leap, we continue to fulfill our moral, societal obligations to "counsel" and advise with learned knowledge, the need for our patients to avert their destructive pathways; and often, until blue in the face.

But let's look for a moment at an underlying stimulus which I propose facilitates this. I believe that our health care system promotes and encourages these behaviors to an extent. And sometimes, the lack of action to prevent such behaviors, can be seen as facilitating. Now I am not a fan of poor grammar, but it does remind me of that FALSE dichotomy statement, "If you're not part of the solution, you're part of the problem". But in a sense, this IS true.

Most of you reading this are probably on the patient care side of the fence. We diligently meet our calling to help, heal and restore people to their "optimal" state of wellness. But there has to be an even stronger counter-measure on the other side of the fence to effect prevention as well.

It is an economic reality that treatment costs MORE than prevention. And it is well-known that effective prevention reduces morbidity and mortality. So the obvious question, "why don't we spend more time, money and effort on prevention?" - goes unanswered.

Without prevention or "access" to prevention (note I did not say access to health care) people are forced into a situation where they cannot gain an interface with the health care system until they enter via the "EMTALA-mandated" Ivory doors to the sacred city of "OZ" (The ED). Upon being integrated into that setting the wheels are at work trying to fit a preventable problem into an acutely ill opening - the technology, resources and costs are not designed for this.

However, we see, treat and encourage our patients - they get better and they are dismissed.

Now, the next time this "need" arises again; guess where the learned behavior is going to lead the patient. They know they got better before in the ED, they still have no "healthcare home", and they are still unchanged in their unhealthy lifestyles.

I propose that the problem is multi-faceted.
Until we can:
-Encourage our system to move towards prevention,
-Re-evalute the principles, AND the necessary/contemporary changes to EMTALA,
-Take a broader recognition of the societal themes of self-entitlement, self-indulgence, self-reward and lack of self-accountability....

...We'll be fighting the same battle over and over ad nauseum.
We need thinkers and people committed to speaking up for what is right.
We don't need a government to tell us to "CHANGE", we need ourselves to recognize the need for change, both internally and in society.

-"KMG-365, Clear..."