Hospital Rats

Remember malls? Remember when they were a thing? If you wanted something that wasn’t food, you went to the mall, that repository of franchised, retail goods. No Amazon, no Shopify. Maybe you had a catalogue, if you were a yuppie, but most of us blue collar kids who pretended to be less poor than we were would go to the mall to work out all the relational drama we instigated during school. There was even a name for these denizens – mall rats.

Foothills Fashion Mall, the local mall in our fair city, was salvaged from obscurity a few years back for no reason anyone can figure, razed to the ground and rebuilt in some “Field of Dreams” delusion that if you build it they will come. Well, neither the retail shops nor the customers came, and has since become a ghost town of empty shops, with a few bored employees folding shirts in the handful of retail joints who can still keep the lights on.

“Remember malls?” I remarked to my wife as we were driving past, where a few lonely cars grazed in it’s asphalt pasture. We reminisced about the huge place they had in our lives. Fast forward 30 years and most business is done online with the goods brought right to the door jamb.

It got me wondering, in a hundred years, what if we could say the same thing about hospitals.

“Remember hospitals?” I may remark to my wife when we are all saggy. Those giant edifices where we went for all our healthcare needs, where the sick thronged and rethronged. What if we could rethink healthcare so that there would be as little use for hospitals as there are malls? It is not a law of nature that healthcare must be brick and mortar.

Is this hyperbole? Maybe. There will always be a need for some kind of surgery in some kind of antiseptic environment, and sometimes people get dealt a bad hand of genetic cards. But as one who has spent a great deal of time working in a number of different hospitals, there is certainly a “hospital rat” mentality that we have, where we think the hospital is the center of communal health and the only show in town where we can get all of our needs met. The locus of health is external to the self.

Can we rethink this from the ground up? We can. I think there are several pieces to this complex puzzle, but essentially they will come down to a few basic ideas. Here they are briefly:

1. Henry Cloud says no one changes outside the context of community. This is tru emotionally, spiritually and I also believe physically. After working in emergency departments for over a decade in multiple states, the number one cause of health issues stem from lack of community. For example, the majority of diabetes in America is type 2, which has as one of its main symptoms insulin resistance from skeletal muscles. With the appropriate caveats, the cure for diabetes is walking. It’s tough to motivate yourself, but if you have 5 people who need to walk, a community of encouragement, challenge and purpose can greatly ease the burden.
2. Education of normal bodily functioning is essential. Not everyone needs to be a body mechanic, but we all should know how to change the oil, rotate the tires, and replace radiator fluid, and why we need to do these things. There should be a level of understanding of the basal functions of the human body that we all possess and then patients need to be challenged to know as much or more about their disease as the provider.
3. Bar far the biggest deficit I see when we promote and teach healthy lifestyles is the reason for being healthy in the first place, which is joy. We want to take care of our bodies so we can enjoy life. Because of centuries of godless universities teaching about body functioning we got in into our heads that we need to properly maintain the function of the body so the body will function properly. At its core our medicine is tautological, uninspiring and pointless. Joy must be the end goal.
4. Necessity of integration of multiple disciplines must be acknowledged. Humans are complex. There is no retaining wall between mind and body, we are not cartesian dualists with a ghost floating around in a skin bag. Our environment, diet, psychology, relationships, beliefs, and purpose all come together in our flesh and manifest in our physical functioning. reas of our experience not previously considered in the realm of health need to be seen as equally important colors of the rainbow spectrum of health. For example, how does the beauty of my environment affect my health, outlook, encouragement and therefore my motivation?
5. Just like your car, the longer the check engine light is one the worse things are going to get. There are not a few stories I have of patients wither saying they could not get in to see their doctor or the did not have one. Just as you need access to auto body mechanics, we need access to body mechanics – physicians, nurse practitioners, physician assistants, physical therapists, psychologists, etc. And I don’t mean being able to squeeze someone in for a 15 minute appointment sometime after the next blood moon, I mean same day. This will require a larger number of providers or at least their dissemination from centralized facilities like hospitals.
6. Costs are prohibitive, but it needn’t be so. Mitigation of costs can be done in several ways, such as taking care of issues before the become issues in the primary setting. But also outrageous osts of health care are augmented by this hideous chimera of inflated costs due to diminishing reimbursement costs from Medicare and Medicaid. If a hospital needs $40 to break even for a procedure and medicaid reimburses 10% then the cost of $400 is not indicative of the true value of the procedure but so much card shuffling to make ends meet. Who pays the $400? Everyone else. These do not represent real numbers but the principle is true.
7. Locus of control for our health is exterior to ourselves. For many individuals, there is little effort made to change lifestyle because the center of decision making is the medical complex. In the back of our minds there is this false notion that “they got a pill for that.” Why walk for 30 minutes when my doctor can up my dose of metformin?
8. Nothing can be for free. This is mostly because nothing is free. The point here isn’t to financially reem people, it is actually meant to be protective. As in many things, cost is prohibits abuse. Free things will be abused because there is no incentive to not abuse them and the end result is an overall increase in cost and a decrease in the valuation of personal health. When we pay for something we have buy in, just like that old adage of the kid who is given a car by his parents and doesn’t appreciate it as the poor kid who saved up his pennies on the paper route to buy his first car.
9. Government must have a fraction of the real estate in health care as it currently does, and it that isn’t obvious after these past two years I do not know what to tell you. The direction of healthcare needs to go in the general direction of privatization and away from the governments beckoning jaws. This point is complicated, however, and needs to be parsed out with very clear boundaries about the peripheral ways local governments can assist the individual in health, such as safe streets, park maintenance, beautifying neighborhoods, as well as low level protective measures such as immunizations for the community.
10. What did Jesus do everywhere he preached the kingdom? He healed people. The church should become the hub of health. It has built in community, accountability, and resources. People meet regularly and can be educated and equipped in all those many colored avenues which contribute to health – finances, diet, aesthetics, counseling, child rearing, etc. For example, a nurse practitioner or physician assistant in each church, depending on size, would be responsible for that body, over 20 churches, say, a physician presides. This would limit the amount of patients to a manageable number, provide frequent interaction and access. My friend coined the term “deacon of health” which has a nice ring to it, a position that could be paid for in a variety of ways.

Why not imagine this? We cannot envision the kind of future where hospitals are as infrequently used as malls given the current state of healthcare. It is all sorts of funky. As we are fond of saying in New Hampshire, “Ya can’t get they-a from hee-ya.” The whole thing needs to be scrapped, and we are already seeing some flowers grow up from underneath this rusting old car that is our healthcare system.