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Who's the Boss of Me?

Posted By Peter Fifield, Wednesday, July 21, 2010
Updated: Thursday, June 2, 2011

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.

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Randall Reitz says...
Posted Friday, July 8, 2011
While I am a proponent of universal healthcare, I share your concern that an insurance model removes us from direct ownership of our health. For people of marginal health, there is little financial consequence for improved or worsened health.

With my employer I use a consumer-driven health insurance model that provides $1500 in health cost coverage every year. If my healthcare expenses exceed $1500 I have an out of pocket percentage up to $10,000 and then complete coverage up to $1 million. The downside is that every health care expense from $1-$1500 comes straight out of this account, including medications. The upside is that any money I have left in the account rollsover to the next year. Preventative care is offered free of charge. In addition, I qualify for an extra $500 each year because I'm a non-smoker, I have a BP under 130/80 and I set health self-management goals through a web portal. I'm in my 3rd year and have so far only spent about $1000 of $4500.

In my mind this a small step toward encouraging preventative care and body ownership.
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