Cutillo Pursuing Health in an Anxious Age

1. Auflage 2016
ISBN: 978-1-4335-5113-0
Verlag: Crossway
Format: EPUB
Kopierschutz: 0 - No protection

E-Book, Englisch, 208 Seiten

A Redeemed and Renewed Vision of Health Despite all the care available to us, our society is more concerned about health than ever. Increased technology and access to health care give us the illusion of control but can never deliver us from the limitations of our bodies. But what if our health is a gift to nurture, rather than a possession to protect? Drawing from decades of medical experience in many different contexts, Dr. Bob Cutillo helps us cultivate a biblical understanding of the relationship between faith and health in the modern age, reorienting us to a wiser pursuit of health for the good of all. Weaving in his own story of serving the most vulnerable, he leads us to a bigger view of health care and a hope that is more secure than our physical wellness-hope with the power to transform our communities.

 Bob Cutillo (MD, Columbia University College of Physicians and Surgeons) is a physician for the Colorado Coalition for the Homeless in Denver, Colorado, an associated faculty member at Denver Seminary, and an assistant clinical professor at the University of Colorado School of Medicine. He has also served as a missionary to the Democratic Republic of Congo. Bob currently lives in Denver, Colorado, with his wife, Heather, and they have two married children.

Autoren/Hrsg.

Cutillo, Bob

Leseproben

Introduction

What Is Health For?

The greatest wealth is health.

Virgil

Health has always been cherished but never controlled. In 19 BC, Virgil, one of Rome’s greatest poets, went to Greece to work on revisions of his most famous poem, the Aeneid. On his way back home, he caught a fever, arrived in Italy weakened by disease, and died in harbor. Though he was only fifty years old, he had already lived longer than expected for his time.1 With little to do when sickness arrived, his awareness of the value of health only emphasized how fragile and precious life is.

American poet and essayist Ralph Waldo Emerson also believed, “The first wealth is health.” When he died in 1882, life expectancy was still less than fifty years. He, too, did not expect a great deal of control over health, living before the discovery of painless surgery under anesthesia, or the knowledge of a microbial world whose infections could be prevented with hygiene or treated with antibiotics.

Things have changed a great deal since then. We now live in a world with greater health and more health care than ever before. Life expectancy in most industrialized countries nears eighty years of age. Diseases such as tuberculosis, which caused the death of Emerson’s wife at age nineteen, can now be cured. Never before has the horizon for health looked so bright or the choices for health care been so varied. From organ transplants to respirators to cancer treatments to genetic mapping, the future seems unlimited, each boundary but a temporary pause in the march of progress.

Yet higher levels of health and greater quantities of health care, rather than creating greater peace and prosperity for all, have been associated with some troubling side effects—greater worry, increased waste, and a waylaid commitment to care for the health of our neighbor.

More Control but Greater Worry

When Joyce and her husband, Samuel, discovered they were pregnant for the first time, she was a graduate student in philosophy. Having delayed starting a family for several years while they pursued further education, getting pregnant at an older age was not as easy as they had planned. But over a year of waiting only made the positive pregnancy test that much more exciting.

They shared their joy with family and friends. Joyce’s sister, a mother of three, told them how important it was to start getting checkups right away and recommended that they see her midwife. But Samuel’s brother, Jacob, a doctor, was concerned that she was high risk because of her older age and recommended a friend of his who was an obstetrician. As usual when the family was dealing with medical issues, Jacob’s advice could not be refused, and on a Tuesday morning one week later they went to see Dr. Abernathy.

He entered the room with apologies for being late. Despite feeling rushed by a full schedule of patients, he took time to review the forms Joyce had filled out, asked one or two questions for clarification, and performed a careful exam and ultrasound. Afterward, he returned to the room to discuss next steps. “Joyce, the ultrasound confirms the date of your pregnancy at two months. Though I see nothing abnormal at this point, I recommend doing further testing to see if the baby is healthy. After all, you’ve waited so long. There are always risks of abnormalities, but at your age it is more likely. Down syndrome is the most common, but there are other problems that are much more severe, even incompatible with life. You do want to take advantage of all the options to insure the health of your baby, don’t you?”

Later that day, as Joyce and Samuel thought back on their visit, three things stood out. First, though Dr. Abernathy was harried, he was genuinely interested in providing high-quality care. Second, they remembered how efficient everyone was, particularly the nurse who came in later to answer their questions about the recommended testing. Finally, and most significantly, they realized something had changed. Tuesday morning they had gone to the office happy and excited, wondering if they would find out whether they were having a boy or a girl. Tuesday night they were worried and afraid. Was their baby physically deformed or mentally defective? Had they waited too long to get pregnant? What tests should they do? What would they do if they found something wrong?

What happened to Joyce and Samuel is not unusual in today’s health care encounter. On several occasions I have met parents-to-be just like them. The joy of discovering they are pregnant can be one of the purest in life. But upon entering the medical system, their wonder and awe at a gift received shrivel before efforts to calculate unknown risks, worries about what bad things could happen, and fretful decisions about how to manage the pregnancy to obtain a quality outcome. How quickly the power to control an unpredictable future and the great possibilities to maximize health can transform joy and hope into calculation and concern. Whether in preparation for childbirth, making preventive health choices, or considering treatment options for cancer or end-of-life decisions, worry has become one of the marks of modern health care.

More Health Care but Increased Waste

Not surprisingly, more health care costs more money. From 1960 to 2010 the percentage of the Gross Domestic Product (GDP) spent on health care in the United States more than tripled, to nearly 18 percent. At about 2.8 trillion dollars, it was more than four times the amount dedicated to defense and three times the amount for education.2 On top of that, individual consumers spend an additional one hundred billion dollars on fitness programs, anti-aging procedures, dietary programs and supplements, and cosmetic skin care products.3 Are we spending too much for health care? If health is our greatest wealth, can it ever be too much? That’s hard to say—unless what we spend is wasteful.

The best estimates are that up to 30 percent of the money we spend on health care is of little or no value.4 Many factors contribute to this problem. Much of health care is fragmented—tests are often repeated and unnecessary medicines prescribed because one health care provider does not know what the other is doing. Unfair pricing produces costs that have little to do with value—patients are often shocked to look at an itemized hospital bill and find a gauze pad costing ten dollars. Doctors practice defensive medicine for fear of being sued, provide treatments to fulfill standard protocols irrespective of particular situations, or order tests rather than talk to patients, because they have so little time. The list goes on, but the result is the same—we end up paying for health care that conveys little or no benefit. And if that weren’t enough cause for concern, what if wasteful spending and too much health care for some means too little for others?

More for Some, Less for Others

The third disturbing trend is our waylaid commitment to caring for our neighbor. As some of us worry about what we can do to insure our personal health and spend larger amounts on things that have little or no benefit, others struggle for even the most basic services. Over the last thirty years, in conjunction with the rapid growth in health care spending and services, the number of uninsured in the United States has steadily climbed.5 The uninsured have greater difficulty finding access to health care than those with insurance, causing neglect of health problems, sickness at more advanced stages, and higher death rates.6 This seems unwise and unjust in a country that spends as much money on health care as the United States does.

Yet the plight of the uninsured in this country, or the poor and marginalized in general, is easily lost in the heated debates over health care reform. In 2012 we spent more than twice per person on health care than most economically developed countries, including France, Germany, or Japan,7 and more than five hundred times what is spent for a person living in economically depressed countries such as the Democratic Republic of Congo.8 Yet the gap continues to grow as fear of losing control of our personal health strains the fabric of concern for the common good. With tunnel-vision focus on how changes in the financing and delivery of health care will affect my health care, we have little room for our neighbor at home and even greater neglect of the huge disparities in global health for our neighbors far away.

The Many Faces of Health Care

As we struggle to understand the worry, waste, and waylaid commitment to others in an age with more stability, certainty, and safety in health than ever before, it may be helpful to consider how complicated health care has become as our expectations for it have grown. No longer just a doctor-patient relationship, it is a complex system with many faces. Spend one day in a hospital bed and you will see it...