Monday, June 15, 2015

Patient-Centered HealthCare : The Dawning of a New Age

This the dawning of the age of Patient Centered Care.  Perhaps this is apparent in primary care and a few other specialties. But what about hospital based specialists and mental health care, euphemistically now named, "Behavioral Health"  Well. what's in a name.?

Psychiatry is the "P" word of health care, much like the C word of cancer. Calling it by another name makes it more comfortable for patients to hear.

When a provider tells a patient, " I am going to refer you to psychiatry" it conjurs up images,  some real, some imagined.  Behavioral health seems to be the term decided by someone in the health herarchy as least frightening to patients.

The problem with the term is that you never know what you are getting in a provider. It is akin to Forrest Gump and his #box of chocolates".  Unless one is seeing a private psychiatrist the road to him is filled with "gatekeekpers" information gatherers and others in the chain of command.

Mental health, behavioral health is not patient-centered. It is shameful.

A scenario.

A patient  has an emergency admission for suicidal ideation, alcohol or drug abuse to a county emergency medical facility.  Once there  he/she is placed in a general  holding area with anywhere from 4 to 10 patients in varying degrees of altered mental state. For some patients, they are placed in isolation as a protective measure. There are no beds in the  unit, only chairs. There is access to a pay phone from which they can call family, or family can reach them. It is a queue with no privacy, patients waiting in line clamoring to call loved ones, acutely anxious with an overriding fear for safety. Patients are there for 72 hours and then must be discharged. It is just an emergency facility for life or safety threatening conditions.

At the end of 72 hours patients are discharged to wherever they may find a home, relatives, friends or even the street.  They can be admitted to an inpatient facility if available.  The ETS is a busy place ,overwhelmed with crisis and limited capacity for holding and patients. There is a wide variety of patients, some psychotic and some with criminal records.  In an effort to control the situation and little means of segregating patients with different levels of behavioral conditions they are indiscriminately placed in one space.

There are no wall placards explaining the process or rights a patient has. In essence all personal freedoms and civil rights are suspended (with good  reason), however it is not open, nor transparent.

The mental health system has been segregated from main stream medicine. The mind-body connection is far more real than a phrase for the 'feel good' niche. Most medical conditons have a connection directly with brain function. Treating one without considering the other leaves a large gap in total health care. Both allopathic physicians and mental health professionalsmust know this. The brain controls the body in ways in which we understand, and in ways that we have not yet delineated. In fact most people do not know we have two brains. One in our head and another in the abdomen. The neural network in the abdomen  has as many neurons and mass as our cerebrum.  And their is a connection,  both humoral and directly by neurons connecting them together.



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