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Cracking the Chronic Disease Dilemna

I read recently in a business magazine about the goal/concept of "cracking the chronic disease dilemma". The article spoke from a business/IT perspective and the focus was coming up with a technological or system solution to this major challenge (it is estimated that this single issue is largely responsible (maybe 75%) for the out of control efforts to finance our healthcare system). I believe that there is a fundamental error in this approach (technological or shifting the delivery model (i.e. to lower level providers such as nurse practitioners or physician assistants or nurses). Not that these are "bad" options; new technology is great and the above mentioned providers are great. The problem is that these efforts would still be in the same model; attempting to care for "complicated, multifactorial" (chronic) problems with an acute care mentality and perspective.

The problem is NOT the providers or the technological support. Fixing these issues could help in a small way by giving overloaded docs support and much needed help but it will not fix the underlying problem. It also is not going to go away with phone triage interventions -- they have tried and failed. Chronic disease is "messy"; it mixes physical problems with emotional and spiritual and social challenges and therefore is not a "quick fix". These additional factors (emotional, spiritual and social) are loaded with complexity and are very often NOT clear and therefore are resistant to rapid (pharmacologic, technological) interventions. This does not mean they are not fixable, workable or within our power to address. It just means that a different approach and perspective is needed.

Chronic disease requires time, listening with open ears without fixed agendas, and dealing with the psychosocial issues that accompany the physical symptoms. This quite often requires a multifactorial approach with a wide array of solutions which often need to work in combination with the other aspects of the healing plan. This can rarely be done in a 10 minute office visit (or 30 for that matter). This also does not usually respond to the standard medical "fixes". However, it can be worked with and made better and the beauty is that when truly and thoroughly addressed, the person becomes stronger in the long run and more resilient in the future. This kind of healing has a power and strength that does not evolve out of acute care interventions (as beautiful as these can be). It has the capacity to make the individual better than they were before (not just back to baseline) but at a higher baseline that can be long-lasting and maybe even permanent!

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