Good Question. A few weeks back my
almost three year old son and I were looking at a poster of the 8
planets. After reviewing the names together it was his turn to try
solo. He began with the sun then to the subsequent planets--pointing to
each one he said "Mercury, Venus, Earf, Mars, Jupatewr, Saturn, Myanus,
and Neptewn”. I offered him encouragement for his job well done and of
course just one correction…”Isn’t it Uranus” I asked him with a slight
grin. "No it’s mine Papa!” he insisted. At that point I could not help
but appreciate what ownership he had of his body. Later, I asked my
wife "At what point do we lose that ownership”?
It is hard to deny that many social psychology concepts have great
significance regarding our health. Three different yet somewhat related
topics come to mind. Diffusion of Responsibility, The Bystander Effect
and Social Loafing—all of which basically state, the more people whom
are involved in a situation, the less likely anyone will take
responsibility for the outcomes of that situation. Usually a population
greater than 10 is needed to see these social phenomena at work. I
can’t help but speculate that maybe there is a direct connection between
these concepts and the state of our health care conundrum. Has our
society created a nanny-istic health system that has become so
protective of its patrons it has reached a point of harm?
Why do I have to look out for my own health? Why should I do it when
someone else will? Due to many driving factors we have managed to
medicalize most chief complaints presented in the primary care setting.
Complimenting these sometimes "every day” medicalizations are a salvo of
pills; a synthesized solution for the infirm. It is no wonder why the
US is last in healthcare, we are trying to fix things that aren’t
fixable or even broken--they are to some degree, just normal. My
challenge as behavioral health provider is to empower people to be
healthier but I continue to ask myself "Who am I to think I have the
power to give back to them in the first place?
So this leads to the pressing question of how do we make this
happen? How do we get people to become more possessive of their own
heath and stop relying so much on medical intervention? How do we not
only shift but balance our philosophical approach so people see their
health as their responsibility not someone else’s? How do we as health
care providers promote patient autonomy? Concepts such as collaborative
patient centered healthcare, and the use of social media options as
well as new medical technologies such as EMR’s "Health Apps ” for
smartphones and other Health Information Technologies can make this job
easier but there has to be more.
How did we end up creating this society based on health nannying…a
sort of protectionist approach that conversely demotes the need for
personal discretion and accountability? Maybe through the
medicalization of our lives we adopted a social loafing perspective of
ourselves; or maybe it is a case of learned helplessness. Either way we
should adopt a new healthcare mantra like "I’m the boss of me”. I’m
not sure when it happened but somewhere down the line we have managed to
give someone else the power over our wellbeing. We have to work on
taking it back. We have to somehow create a balanced healthcare
delivery system where public and private sponsored healthcare options
create a conduit that facilitates access to quality and evidence based
care and simultaneously creates a venue where people have personal
autonomy and accountability to themselves.
Typically when I find fault in a process I try not to opine unless I
have a few potential solutions. Who do we blame for this mess: the
medical model, the mere existence of health insurance, the need for a
listed cause of death on death certificates or the drug companies—maybe
all of the above? I’m at a loss here, possibly due to the magnitude and
complexity of it all. That being said, this topic is too important, to
forego a comment this time around even though I have no proposed
solutions. Ultimately we have to ask: How do we shift the healthcare
paradigm and truly allow people to be accountable for their health.
Then we have to ask, "what do we do” if they don’t want it.