Posts tagged: Anxiety

Protesting Economic Inequality

It may become an important historical phenomenon, or become a discard on the scrapheap of history.  There are people gathering all over the Western world to protest economic inequality.  The media tends to focus on the lack of clarity and singular purpose in their message.  Conservative media outlets portray the protesters as borderline communists.  Liberal media outlets portray the protesters as noble iconoclasts.  Neither interpretation is very accurate.

Corporate and institutional greed is painted as a particular sickness of our time, but it is hardly a new phenomenon.  Let us consider corporations and institutions to be private and governmental bodies (respectively) that initially fulfill the desire of a particular group.  Both institutions and corporations attempt to fulfill a particular social need; be it health, spirituality, security, shelter, food, et cetera.  As an institution ages, it increasingly fulfills the needs of its directors, at the expense of those it was designed to serve.  Institutions that begin their life in transparency become opaque with age; increasingly insular and jealous of their privileges.  Compare the Catholic church at the first ecumenical council in AD 325 with the what the church had become by the time of the inquisition(s)-twelve hundred years later.  Compare the French nation at the time of Charlemagne with French government by the time of Louis the fourteenth-fifteen hundred years later.

With an increase in population there is an automatic decrease in the personal control enjoyed by individual members.  With an increase in population there is a corresponding decrease in personal responsibility of the populace to the institution.  With an increase in the geographic distance between members and directors, there is a net decrease of the director’s personal responsibility to those that depend upon them.  If there is little chance that a member will have social contact with a director, the director will automatically have greater freedom to impose unpopular rules on the members.  Perhaps this is an emergent property of population growth upon the nature of institutions and corporations.  Perhaps it is an emergent sociopathic tendency of those who need to control others.

A loss of control tends to increase personal angst.  More than one commentator has used the word “angst” to describe the emotional tone of the protesters.  There is a palpable fear of the future; an anxiety over their children’s experience of the world.  If the current Western socioeconomic systems remain static, parents will fail to maintain the modern social compact with their children.  Each generation shall enjoy greater prosperity than the one preceding.  It is the largely unspoken social compact between parent and child in much of the Western world.  Over the last three years, an awareness of the individual’s lack of power and worth has become all to apparent.  People are increasingly confident that the next generation will be less prosperous than the last generation.  It is likely that this awareness has fueled the current protests.

Five hundred years ago, Thomas More wrote that “I see nothing but a conspiracy of the rich, who are aiming at their own advantage under the name and title of the commonwealth.  They invent and devise all ways and means by which they may keep without fear of losing all they have amassed by evil practices, and next to that may purchase as cheaply as possible and misuse the labour and toil of the poor.”  The same could be written a thousand years before in the Western world, and perhaps three thousand years before in the Eastern world.  From Socrates to Marx, great thinkers have pondered the sickness of social and economic inequality.  Socrates believed slaves and idle thinkers were indispensable to a republic, versus Marx who believed that both were evils unto themselves.  If two of the greatest thinkers in Western intellectual history are unable to agree on the ideal society, how can the media criticize a group of people in the park for failing to provide a solution?
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The solution is for all public institutions and private corporations to become more transparent and regulated by the members they serve.  Lewis Mumford wrote that,”any group that operates in secret…loses touch with reality by the very terms on which it operates.  What begins as the suppression of a critical opposition ends with the suppression of truth and the elimination of any alternative to the accepted policy, however patent its errors, however psychotic its plans, however fatal its commitments.”  This statement holds true for both the Catholic church during the Reformation and Lehman Brothers during the last financial crisis.  The directors of modern society, as in all past societies, have no motivation to change the system by which they profit.  It is unfortunate that society does not change with great ideas, rather it changes when the directors become fearful of the members.  Any system that does not impose constant scrutiny on its directors will find itself in the present situation.  Transparency and accountability are the answer.  The present protests are an indicator of frustration, not a process leading to a solution.  It can be taken for granted that imposing transparency and accountability will not be accomplished with the cooperation of the directors.  The issue is less what must be done, than how it will be done-if it will be done at all.  Perhaps Robert Crowley can summarize these thoughts better than the author.  He penned these eerily apt lines in the sixteenth century:

And this is a city in name but in deed

It is a pack of people that seek after meed (profit)

For officers and all do seek their own gain

But for the wealth of the Commons not one taketh pain.

And hell without order I may it well call

Where every man is for himself and no man for all.

Hospitalist Versus Primary Care-What Really Makes Us Well

A recent article in the Annals of Internal Medicine was very interesting.  It is research to determine the cost effectiveness of hospitalists versus primary care physicians.  A hospitalist is a physician that specializes exclusively in hospital care, and the primary care physician is the family doctor that is familiar to most people.  Family physicians may receive additional training to become a hospitalist, but most hospitalists are boarded in internal medicine-sometimes in combination with other specialties.  Historically, a primary care physician was allowed to visit and consult on their patients in the hospital.  About a decade ago, insurance companies discouraged hospital visits from the Primary Care Physician (PCP), in preference to physicians that were specifically trained to perform inpatient care-the hospitalist.  At first blush, this change in physician practice appeared to make good sense.  It provided an economic incentive for hospitalists to limit their practice to the hospital.  At the same time, it limited the economic incentive for primary care physicians to visit their hospitalized patients.  It seemed like a good method to avoid duplicate charges and overlapping skills.  It assumes the hospitalist provides similar or better care than the PCP.  The outcome research does not appear to support this conjecture.

The research by Kuo & Goodwin (2011) compared five percent of all enrollees to Medicare from 2001 to 2006.  The positive side of  hospitalist care resulted in a shorter hospital stay (about half a day), and a total savings of fifty Medicare dollars on every hospitalization.  This is in comparison to management by the patient’s community based PCP.  Unfortunately, examination of the elderly patient’s usage of the Medicare system after discharge told a different story.  Patients cared for by hospitalists resulted in significantly greater emergency room visits after discharge, more frequent use of nursing facilities, more frequently readmissions to the hospital, and patients were less likely to be returned to their home after discharge from the hospital.  The authors concluded that the “decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge.”  There are several limitations to this study; for example the patient sample was largely elderly (selection bias), the period examined after discharge from the hospital was only thirty days (decreased power to extrapolate), and the statistical methods used may not be the most appropriate.  On the other hand, no other studies of this type, let alone size and scope, have been brought to this author’s attention.

According to Wikipedia, the Chapter 13 United States Bankruptcy Code lists forth the statutes governing the various types of relief for bankruptcy in the United States. pharmacy levitra http://nichestlouis.com/viagra-5961.html On this occasion, you should clear what’s 100mg viagra price going wrong between endometriosis and pregnancy. They interfere with the secretion of PDE5 means more blood flow to the penile organ and many physical conditions on line viagra important site can restrict the blood flow to the penis. Email us .Website: generic in uk viagra www.powerkhan.co.ukJoin Us: Twitter | Facebook | Google+ . The research does not appear to make sense.  Primary care physicians are primarily trained for community-based care.  Hospitalists should have greater knowledge and experience providing care to the inpatients sampled in this study.  The inherent advantage of the primary care physician is their prior knowledge of the patient’s medical history, and their personal relationship with the patient.  It is likely that the first factor is less important than the second for a couple of reasons.  The medical history of nearly any patient is easily communicated to another physician.  Most conditions are so common they have two to three letter abbreviations understood by nearly any clinician who studied in the United States.  The elderly subjects used in this retrospective study will tend to have more extensive medical histories than younger patients.  A small minority of subjects used in this study would have complicated or unusual medical histories that could not be reduced to a few abbreviations.  These study subjects may be at a disadvantage when under the care of a hospitalist.  Their history may not be fully understood by the PCP, and/or the notes obtained from the PCP may not be sufficient to direct medical care.  It is believed that these complicated hospital admissions represent a small fraction of the total hospital admissions sampled by this study, though there is no direct proof of the same.  This study also lacked an examination of premorbid mental health issues on the functional outcome of patients.  Depressive or anxiety disorder patients may have a greater need for a personal relationship with a physician, as reflected by greater usage of Medicare funds after discharge from the care of a hospitalist.

A primary care physician’s personal relationship with the patient is an important variable that separates the hospitalist from the PCP.  If all else is held equal, including skill and experience, this factor looms as a gigantic independent variable.  The dependent variable in this study is the patient’s health status after discharge from the hospital.  The independent variable of faulty communication between PCP and hospitalist cannot be ruled out or held as trivial, yet it is certainly less pervasive than then the personal relationship enjoyed by the PCP.  Sometimes this is referred to as “nonspecific factors” that are essential to health.  It is not that clinicians are unable to be specific in talking of these issues, it refers to the scientific difficulty of objectively measuring and comparing the features of a doctor-patient relationship.  Nonspecific factors in psychotherapy (patient’s perspective) include feeling accepted, being understood, being encouraged to overcome difficulties, being respected, and having someone interested in their welfare.  This research suggests that a preexisting personal relationship with a physician leads to increased patient wellness after a hospitalization.  Many of these nonspecific factors are crucial to a positive psychotherapeutic outcome.  It is a greater conceptual stretch to suggest that a personal relationship with one’s physician is crucial to a positive medical outcome.  Perhaps it is not crucial to physical health, but this study suggests that a medical doctor’s personal relationship with the patient is very important-regardless of diagnosis.