I spent seven years trying to learn how to treat individual patients. The first few years were devoted to learning the anatomy, the pharmacology, the body systems, and their intimate connections. Then I got to work with patients. As a medical student, I was usually the fourth or fifth person to ask this poor wretch their history, their symptoms and then the last to ineptly examine their body and try to make my own conclusions about what was wrong and what needed to be done. Three more years of residency taught me to sleep when I could and manage my time while honing these patient evaluation and treatment skills.
Then, when I went out into the real world of clinic, community hospital and billing insurance the real education began.
All this training was focused on my individual treatment of the individual patient. I learned to do my best for my patient.
Something drew me (it’s a long and funny story) to be a county coroner. My training of anatomy, pathology and human behavior helped me a lot, but the deceased was not my patient (though sometimes they had been). I was working for the county, the public, the voters since I sought to be elected to this position. But those many investigations: the suicides, young and old, the poverty, the isolated mentally ill, the child deaths pulled me to look at the bigger picture of health.
I asked for some research from the state to understand where people in my county were dying. It turned out about 25% died in the hospital, about 25% at home or on a highway and about half the deaths in our county occurred in nursing homes. This was at a time (twenty years ago) when 80% of deaths nationally were in a hospital. It has now dropped to about 60%, yet almost 80% of people, when asked, say they would rather die at home.
I asked our hospital to study the deaths that occurred there. Of the deaths that were in the hospital, most came in with an acute event (stroke, heart attack, pneumonia) and were made better in a day or two, but then declined. Most the deaths had family in attendance and were accepted, supported.
These questions, and the answers I got made me feel pretty comfortable with our community care. All doctors want to reduce deaths, but we all know it is inevitable. When I was in training there was no such field as Palliative Care, though Elizabeth Kubler Ross’ book, On Death and Dying had been published many years before.
In the first three years in the coroner job, I had three dead children, killed by one of their parents. I spent a few years studying child abuse and how to prevent it. We instituted universal child death investigations and reviews for our county, back when Idaho was the only state that did not have such a policy. We developed a program to help new moms who might feel overwhelmed.
When a doctor sees a patient in the office, there is a clear expectation that the doctor is treating the patient. But the home (or lack of it); the family and friends (or their absence) often become part of the treatment concern. The circle of care often must be broadened to better understand the disease, and the treatment.
So, when public health departments started getting flak from the state legislature this last session, I wondered, just who the heck were they mad at? Who do you want making recommendations to policy makers about public health decisions?
I got my answer when The Ada County Commissioners chose their doctor for their public health board.
If you want some crazy treatment for what ails you, you have the freedom to shop around and find some doctor to support your whims. But public health is for everybody, not just those that agree with you.