Is Spirituality a Part of Health Care?
Would you be willing to pay a doctor specifically for telling you to walk a mile each day? (I said "would" not "should") Would you be willing to pay a little more into your employer-sponsored health plan so all your co-workers and families can go to yoga classes twice a week? There is much that goes into all that is involved in the patient-provider-payor struggle for defining what is "medicine." For good or bad, it's all about costs, coverage, and reimbursement. I'll argue this is what defines "medicine." Despite all the apparent impropriety, injustice, or unfairness, I think this system provides enough checks and balances that it is the way it should be defined until some paradigm shift occurs in our attitudes about money and health.
dras
Comments to Reply:
[D-]> Would you be willing to pay a doctor specifically
> for telling you to walk a mile each day? (I said
> "would" not "should")
[RS]
If this is medical prescription to help a condition I
have, then I would pay the doctor to give that
prescription. Maybe the cardiologist says do not walk
much because it is dangerous for your condition. I
would also pay for this prescription because
cardiologist knows better than I know about heart
disease and specifics. You would not pay for this
expert guidance from highly educated doctor?
[D-]
In our reimbursement world, when a qualified doctor evaluates the medical condition of a patient and advises a patient to walk, or not walk a mile each day, it's called an evaluation and management episode of care. More specifically, I'm asking if that episode of care should be further broken down to the level that the physician should expect unique reimbursement, aside from whatever other intervention is performed or recommended, for advising the patient about a 1-mile walk. I'm not trying to be as cynical or trite as the question sounds. Similar instances happen all too often in real-life, and the topic has a long history: http://www.cms.hhs.gov/Transmittals/downloads/R954CP.pdf
[D-]> Would you be willing to pay a
> little more into your employer-sponsored health plan
> so all your co-workers and families can go to yoga
> classes twice a week?
[RS]: No I would not because this is not prescription for
specific condition advised by doctor to specific
patient with specific medical condition where it is
useful.I would not pay more in my plan so everyone
could go swim in pool at the YMCA because they enjoy
to have a dip. I would pay more to go swim myself if
expert doctor gives me the prescription telling me it
is very useful for my specific medical condition of
physical or mental illness.
[D-]
How about a willingness to pay for a home spa for your co-worker prescribed by his expert doctor for his chronic back pain? A health club membership prescribed for his fibromyalgia? A custom-built GMC van prescribed for his peripheral neuropathy? A personal massage therapist prescribed for his chronic malaise and fatigue?
[D-]> There is much that goes into
> all that is involved in the patient-provider-payor
> struggle for defining what is "medicine." For good
> or bad, it's all about costs, coverage, and
> reimbursement. I'll argue this is what defines
> "medicine."
[RS]:This is wrong. Maybe this is how it becomes necessary
because of economics but that does not make it the
right definition. Medicine is to cure and prevent
disease and also to ease the bad symptoms. It is not
to decide cost and reimbursement. Maybe the cost and
reimbursement makes this difficult for many to get
medicine but this does not make the definition of
medicine change for that reason.
[D-]
I agree, economics should not define what is considered medicine. But our degree of willingness to put a value on a service does.
[D-]> Despite all the apparent impropriety,
> injustice, or unfairness, I think this system
> provides enough checks and balances that it is the
> way it should be defined until some paradigm shift
> occurs in our attitudes about money and health.
[RS]: I think this is what would be sophistry. The question
is what is definition of medicine, what treatments and
offers and not what is restricted because of economics
that makes medical practice unavailable for some.
Richard Singh
[D-]:
Not sophistry, as I see it. It's my understanding of how our society that uses a third-party payment system for medicine defines what is considered "medicine." The definition is influenced within a semblance of checks and balances created by the provider, patient, and the payor. Unfortunately, priorities for all three groups are often economic-based. I only defend it in comparison with the alternative of government socialized medicine, that removes the patient or consumer from the equation and leaves the definition to only providers and the government payor. And the alternative of unregulated consumer-driven health care, which comes with the risk of sacrificing science and legitimacy from the definition.
The enigma of medicine lies within the philosophy of the definitions. Those with a more relativistic view of medicine are much more comfortable calling yoga, various CAM modalities, and even "spirituality", medicine. The dangerous consequences of promoting a relativistic philosophy toward the idea that whatever impacts health is therefore medicine are three-fold, as I see it. One, we foster a mistaken association that all medicine is relatively beneficial. For example, I might come to falsely believe that if I pray, do yoga, and have surgery for cancer, I can do without chemotherapy, and expect the same outcome as if I'd done the chemotherapy and left out the yoga. Two, we risk creating the same attitude of entitlement for all "medicine" that we currently have for doctor and hospital-based medicine. That is, we expect Medicare, private insurance, or someone else besides ourselves to provide us with whatever "medicine" we feel we need at the time. Three, we then
travel precariously closer to accepting state-sponsored religion. If I use a relativistic basis of medicine to infer that a specific vitalistic (faith-based) belief or modality improves health outcomes, and can convince congress/CMS to pay for it, I can compel you to at least fund it, if not accept it.
I do not know what should be called "medicine." But I would like to be empowered with the tools to create a definition for myself, and the freedom to act on my decision, whether financially or personally. I'm very comfortable calling religious ideals and personal values a type of medicine, and I hesitate to argue against whatever talisman, ritual, or belief system any individual believes is keeping or making them well. I also think we should hold on to our traditional value of charity in health care. As a (U.S) nation, we want everyone to have access to medical care, and have always subsidized those who are less fortunate in health and wealth than ourselves. I hope we continue in that attitude, and the current trend of consumer-driven health does not leave more people out-in-the-cold due the collective selfishness of those of us who are more well or wealthy.
Best Regards,
dras
dras
Comments to Reply:
[D-]> Would you be willing to pay a doctor specifically
> for telling you to walk a mile each day? (I said
> "would" not "should")
[RS]
If this is medical prescription to help a condition I
have, then I would pay the doctor to give that
prescription. Maybe the cardiologist says do not walk
much because it is dangerous for your condition. I
would also pay for this prescription because
cardiologist knows better than I know about heart
disease and specifics. You would not pay for this
expert guidance from highly educated doctor?
[D-]
In our reimbursement world, when a qualified doctor evaluates the medical condition of a patient and advises a patient to walk, or not walk a mile each day, it's called an evaluation and management episode of care. More specifically, I'm asking if that episode of care should be further broken down to the level that the physician should expect unique reimbursement, aside from whatever other intervention is performed or recommended, for advising the patient about a 1-mile walk. I'm not trying to be as cynical or trite as the question sounds. Similar instances happen all too often in real-life, and the topic has a long history: http://www.cms.hhs.gov/Transmittals/downloads/R954CP.pdf
[D-]> Would you be willing to pay a
> little more into your employer-sponsored health plan
> so all your co-workers and families can go to yoga
> classes twice a week?
[RS]: No I would not because this is not prescription for
specific condition advised by doctor to specific
patient with specific medical condition where it is
useful.I would not pay more in my plan so everyone
could go swim in pool at the YMCA because they enjoy
to have a dip. I would pay more to go swim myself if
expert doctor gives me the prescription telling me it
is very useful for my specific medical condition of
physical or mental illness.
[D-]
How about a willingness to pay for a home spa for your co-worker prescribed by his expert doctor for his chronic back pain? A health club membership prescribed for his fibromyalgia? A custom-built GMC van prescribed for his peripheral neuropathy? A personal massage therapist prescribed for his chronic malaise and fatigue?
[D-]> There is much that goes into
> all that is involved in the patient-provider-payor
> struggle for defining what is "medicine." For good
> or bad, it's all about costs, coverage, and
> reimbursement. I'll argue this is what defines
> "medicine."
[RS]:This is wrong. Maybe this is how it becomes necessary
because of economics but that does not make it the
right definition. Medicine is to cure and prevent
disease and also to ease the bad symptoms. It is not
to decide cost and reimbursement. Maybe the cost and
reimbursement makes this difficult for many to get
medicine but this does not make the definition of
medicine change for that reason.
[D-]
I agree, economics should not define what is considered medicine. But our degree of willingness to put a value on a service does.
[D-]> Despite all the apparent impropriety,
> injustice, or unfairness, I think this system
> provides enough checks and balances that it is the
> way it should be defined until some paradigm shift
> occurs in our attitudes about money and health.
[RS]: I think this is what would be sophistry. The question
is what is definition of medicine, what treatments and
offers and not what is restricted because of economics
that makes medical practice unavailable for some.
Richard Singh
[D-]:
Not sophistry, as I see it. It's my understanding of how our society that uses a third-party payment system for medicine defines what is considered "medicine." The definition is influenced within a semblance of checks and balances created by the provider, patient, and the payor. Unfortunately, priorities for all three groups are often economic-based. I only defend it in comparison with the alternative of government socialized medicine, that removes the patient or consumer from the equation and leaves the definition to only providers and the government payor. And the alternative of unregulated consumer-driven health care, which comes with the risk of sacrificing science and legitimacy from the definition.
The enigma of medicine lies within the philosophy of the definitions. Those with a more relativistic view of medicine are much more comfortable calling yoga, various CAM modalities, and even "spirituality", medicine. The dangerous consequences of promoting a relativistic philosophy toward the idea that whatever impacts health is therefore medicine are three-fold, as I see it. One, we foster a mistaken association that all medicine is relatively beneficial. For example, I might come to falsely believe that if I pray, do yoga, and have surgery for cancer, I can do without chemotherapy, and expect the same outcome as if I'd done the chemotherapy and left out the yoga. Two, we risk creating the same attitude of entitlement for all "medicine" that we currently have for doctor and hospital-based medicine. That is, we expect Medicare, private insurance, or someone else besides ourselves to provide us with whatever "medicine" we feel we need at the time. Three, we then
travel precariously closer to accepting state-sponsored religion. If I use a relativistic basis of medicine to infer that a specific vitalistic (faith-based) belief or modality improves health outcomes, and can convince congress/CMS to pay for it, I can compel you to at least fund it, if not accept it.
I do not know what should be called "medicine." But I would like to be empowered with the tools to create a definition for myself, and the freedom to act on my decision, whether financially or personally. I'm very comfortable calling religious ideals and personal values a type of medicine, and I hesitate to argue against whatever talisman, ritual, or belief system any individual believes is keeping or making them well. I also think we should hold on to our traditional value of charity in health care. As a (U.S) nation, we want everyone to have access to medical care, and have always subsidized those who are less fortunate in health and wealth than ourselves. I hope we continue in that attitude, and the current trend of consumer-driven health does not leave more people out-in-the-cold due the collective selfishness of those of us who are more well or wealthy.
Best Regards,
dras
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12:53 PM
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