Guardians of the Public's Health

Effectiveness of NonEmergency Health Care

  • 07 Sep 2011 7:27 PM
    Message # 694025
    Anonymous member (Administrator)
    Submitted by  Richard W Biek MD MPH
    Dear Colleagues,
     
    Everything that is done to improve human well-being
    should be evaluated on the basis of actual results.
    A simple monitoring device is the Well-Being Index
    collecting data from the world's greatest experts.
    Almost all of us are the world's greatest expert on
    our own well-being.
     
    Simply report before and after and continuing results
    of programs or activities upon such an index. If human
    well-being is improved, do more of it. If not, do less or
    none of it.
     
    The three main parts of wellness are how happy,
    healthy and satisfied with life we are. A simple 5-point
    scale can be used to answer 3 questions.
     
    How happy am I now?
    How healthy am I now?
    How satisfied am I now?
     
    1 = very unhappy, 2 = somewhat unhappy, 3 = not
    sure or no comment, 4 = somewhat happy, 5 = very
    happy. Similar scores for how healthy and how
    satisfied. The grand total ranges from 3 to 15.
     
    For any individual, group, or population, increasing
    an average Well-Being Index indicates improvement.
     
    Unless we have reliable data to confirm we are doing
    more good than harm, we should not be doing
    whatever we are doing. Interventions when the total
    is at or near 3 are most likely to do good. Almost all
    interventions for nonemergencies do more harm than
    good, including preventive efforts.
     
    Nonintervention in nonemergencies improves 90%
    of outcomes. Unless more than 90% get better, our
    efforts are doing more harm than good.
     
    Sincerely,
    Ric
    Richard W Biek MD MPH
    Biek Public Health Consulting LLC
    8501 Old Sauk Rd   Apt 131
    Middleton WI 53562-4380
                608-662-9319      , Fax 608-662-0514
  • 13 Sep 2011 8:02 PM
    Reply # 698873 on 694025
    Anonymous member (Administrator)
    Submitted by Joel Nitzkin
    Richard:
     
    I question the validity and utility of your proposed questionnaire instrument. To my knowledge, the questionnaire you are suggesting has never been field tested, standardized or validated.
     
    The issue you are addressing was extensively covered in the 1970's and 1980's with the development of what were then called Health Status Assessment  or Quality of Life Assessment questionnaire instruments and evaluation protocol.  These are still in current use, although I doubt that there is much in the way of current literature.
     
    The classic and best standardized of the questionnaires is the SF-36.  You can learn more about it by going to www.sf-36.org. It asks 36 multiple choice questions having to do with physical and mental health status, social functioning and productivity.  Usually these are completed in the physician's waiting room, on a computer-readable paper form, then scanned into the desktop computer that gives scores on eight scales of current health status and quality of life.  Abbreviated sf-12 and sf-20 instruments have also been developed, as well as a number in different languages and for different age groups.
     
    If you google Health Status Assessment or Quality of LIfe Assessment you will see a lot of material on these and similar instruments.
     
    These instruments should not be confused with Health Risk Assessment questionnaires that ask about family history, smoking, diet, etc, for the purpose of predicting risk of premature death.  Lifestyle Directions has one of the classic instruments in this field. The earliest HRA questionnaires were developed by CDC in the early 1970's and expressed its result in terms of giving the patient an estimate of his or her "biological age" as compared to his or her actual chronological age. Someone at high risk could have a "biological age" 20 years older than their calendar age.  By the same token, someone in good shape could have a "biological age" 20 years younger than their chronological age.
     
    Both  types of questionnaires come with protocols for use and assessment on individual patient and population levels
     
    Joel L. Nitzkin, MD
     
     
  • 13 Sep 2011 8:15 PM
    Reply # 698877 on 698873
    Anonymous member (Administrator)
    Contributed by Richard W Biek MD MPH

     Dear Joel,


    Unless we track responses from those we serve to verify that
    over 90% report improvement, we are doing more harm than
    good compared to nonintervention.
     
    I know my Well-Being Index is very quick and reliable. Blue
    Cross - Blue Shield wrote to me -- after I had been making
    home visits for 3 years doing only positive health promotion
    with no diagnosis, treatment, nor or advice, and all reported
    improvement -- that those who call me their doctor used to
    cost the health insurance company thousands of dollars a
    year but now cost nothing.
     
    Or track deaths that occur during or within 10 days of
    health care. Add the last date of health care to death
    certificates to make it easy to get data.
     
    When doctors go on strike, deaths at all ages from all
    reported causes drop from 17% to 60% in less than 10
    days.  Deaths stay down till the strike ends, and in less
    than 10 days, deaths increase 20% to 120% back to the
    level before the strike. Israel has had the most doctor
    strikes, and morticians mediate a quick end to the strike
    or go out of business.
     
    Deaths during and up to 10 days after care are several
    times more numerous than in any 10 days not associated
    with health care.
     
    From 1926 to 1961, longevity increased steadily in USA
    from 56.7 to 70.2 years. Every 1.6 days we lived 1 day
    longer. It was still 70.2 years in 1968. For over 2500
    days, we did not live 1 day longer. 
     
    That was when doctors opposing socialized medicine 
    saw patients even if they could not pay, but Medicare
    and Medicaid were enacted in 1965 anyway. Each year
    millions more patients were seen than the year before.
     
    After 1968, health care visits began to level off, and
    we began to live longer, but it took 5 days to live 1
    day longer. 2004 -2006, we even lost 36 days of life.
     
    Except in emergencies, medical and surgical care do
    much more harm than good. I know if doctors are 
    kept informed of how many deaths and complications 
    they cause during and up to 10 days after care, they
    will begin to find ways to reduce them. That is not
    happening now. What do you think will work?
     
    Ric
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