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Saturday, December 25, 2010

Failures of Health Class

I have remarkably fortunate in terms of illness in my family. My children have experienced a variety of health problems, some of which required hospitalization. However, my wife and I are medical professionals and we have know how on how to deal with the medical delivery system. We knew when specific issues needed to be dealt with immediately and where to go to effectively solve specific problems.

Both of my parents have been remarkably healthy until very recently, which I have viewed as a remarkable blessing. Over the past month, my father has developed some new health issues and each time my parents have health problems or encounters with the health care system,  I learn I have some new blindspot when it comes to appreciating the health care system. I have come to realize is that minor health concerns which force one to interact with elements of the health care delivery system as like small dress rehearsals for when something major comes along. Without these dress rehearsals, even the most educated and together people are ill prepared to deal with new and major health issues.

My medical education and even more so my experience in practice has taught me about effective approaches to managing illness (even my own) and the capabilities and limits of current medical care. The question is, how much of this knowledge base is part of an ordinary education? The answer is almost none. It made me think back upon my own education prior to my dive into medicine. I recall my first exposure to human health issues, that being health class in middle school and high school. It was an absolute joke focusing (rather ineffectively) on sex ed, sexually transmitted diseases,drugs and alcohol. While these are rather high stakes issues and I do not want to discount any importance of any effective approaches to deal with this, two obvious observations remain.

First, the courses were a joke and completely ineffective. Those who taught them tended to be poorly prepared and the brunt of jokes. From what my own grown children tell me, there has been little change since I was growing up. Second, the range of experiences I have had dealing with health issues both personally and professionally had focused on a set of experiences which is completely distinct from what was highlighted in my health classes. What perhaps is most striking is the complete lack of any practical knowledge regarding how to navigate the health care delivery system when an individual or family member is ill.

What struck me about my father's recent health issues is how completely unaware my parents were about how to deal with basic health issues. They had no notion of what constitutes urgency, what issues they should be concerned about and which ones were less ominous, and where they should go to have specific issues addressed. They are both very intelligent and well read and have a lifetime of experience in other realms. It is nothing short of remarkable that such highly educated people can have such a huge blind spot.

Perhaps it is not that surprising since our present education system is rather biased away from practical knowledge. Health education professionals are rewarded to focus on high profile and titillating public health targets such as sexually transmitted diseases and obesity despite the apparent futility of such quests. It is my opinion that the time would be better spent educating people about perhaps more mundane but very practical aspects of health and health care.

This could include simple rules based approaches to ubiquitous illnesses. Virtually everyone can expect to develop URI's, a myriad of GI illnesses, urinary tract infections, yeast infections, dermatitis, wheezing, lacerations and abrasion, sprains and possible breaks, and soft tissue injuries. All of these common scenarios have rules based protocols which should not be viewed as trade secrets. It is nothing short of bizarre that students complete a college education and have no clue as what to do when they (or a family member such as a child or older parent) develop a respiratory infection. Health class would perhaps better serve their needs if were lighter on the diatribes focused on firearms, water pollution, overeating and refocused on common and predictable issues which drive health care service consumption. For example, perhaps we should impart the know how as to what to measure (temperature, respirations, pulse, BP) and when a visit to an urgent care setting is recommended. What medications should be routinely stocked and used.  What to do about dehydration, nausea, vomiting, or diarrhea? Again when and who to call and when an ED visit might be in order.

Redirecting efforts to educate and impart practical knowledge may also establish credibility for health curriculum. Spending time and money trying to focus on convincing people to not do what they want to do is is a recipe for failure. Mixing in some practical knowledge for dealing with issues that make them feel bad is more likely a winner.

Given my own recent experience with parent health issues, I am tempted to also push for inclusion of family health issues into a practical health curriculum. While our own aging will be part of our lives (hopefully), the aging or our parents will almost certainly precede this (barring their or our early demise). Our educational system fails to prepare us in any practical way for either our own or family aging issues.  I have my doubts this would be effective. Health curriculum generally includes normal growth and development but oddly enough development seems to stop once adulthood is reached. The absence of any recognition of aging may be justified on the basis that the target audience suffers from the illusion of immortality and this information would fall upon deaf ears. However, the lack of any information acknowledging aging as part of normal development may be part of the problem.

I could go on and on but I won't. There may be exceptions and I would love to be made aware of a curriculum which addresses these more practical considerations. I suspect they are few and far between. There is a common thread which I touched upon in an earlier piece I wrote about medical knowledge vs. know how. We are still experiencing the legacy of the Ancient Greeks and the clash between the philosophies of Sophists focused on practical knowledge and the school of Aristotle and Plato whose focus of education was on the search for timeless and universal truths. Timeless and universal truths are important. For an educational institution they will put you on the map but for the rest of the world, education also needs to transmit practical knowledge. It is the glue that holds complex societies together. 

1 comment:

  1. You are quite right. The public's medical literacy is wanting. Many are filled with misinformation, which may be more dangerous thatn ignorance.