If I would decide how hospitals are governed (and I don’t), these would be important points for me:
1. Food: Thy food be thy medicine – and vice versa – Hippocrates said. What is served as “food” in hospitals these times, is mostly abysmal and just goes to show that conventional medicine is not interested in really finding out the root cause of disease. In many cases, it is nutrition, stupid!
2. Cafeteria: Same for the place where all the visitors come and eat. It could be an educational experience, instead just another gorging with inferior foodstuff, filled with chemicals, trans-fats, sugars and dairy.
3. Quiet: When I was a child in Germany, and my father was a doctor, he used to take me on his rounds. Hospitals then were very quiet places. The nurses (often nuns) would walk on their rubber soles like on cushions, and they spoke with low voices. The doors to patient rooms were double doors – the patient had privacy and quiet.
4. What hasn’t changed much: That the hospital routine is not geared toward patient recovery but to a ward schedule convenient for doctors and nurses: Then as now patients are pulled out of sleep to measure their temperature or draw blood tests at four am. I would like to see more concern for the patient’s wellbeing than for the organization’s.
5. No TV in patient rooms: My guess is that at least seventy percent of all illness is self-inflicted. It used to be that being in the hospital was a time for contemplation about what brought one there. Not any longer – as TV is squeaking and squealing day and night.
6. Conventional and complementary medicines are BOTH used. There should be no bias toward the one or the other – what has been proven to work should be applied: Hydrotherapy, movement therapy, food, herbal medicine and art, music, journaling, acupuncture, massage, and so on – they all should be used to make patients better. As they are in most European hospital. And paid for by national health insurance. And, no, they are NOT going to be broke …
7. More cleanliness in the facilities. More cleanliness of the patients. Used to be that hospital were spic-and-span places where you could eat from the floor; not any longer. Instead of on cleanliness we trust in antibiotics – to our detriment. Same with patients’ cleanliness: Used to be that nurses washed the patients daily; not any longer. Nurses have gone scientific (necessarily so – but who is now responsible for caring?); the paperwork has become overwhelming. Housekeeping has been out-sourced. And simple ideas like a washing and cleaning have become obsolete. But hospital infections are skyrocketing.
8. More friendliness and caring toward the patient. The patient has become a moneymaking device.
9. Less care and resources to be spent on very old, very sick people in their last days of life – more on pediatric and under-served populations. DNR (Do Not Resuscitate orders discussed with every patient and/or every family). It will lead to savings of money and will allow people to die with dignity.
10. In medical schools, only half of the students should be A+ nerds; the other half should be people who really want to become doctors and patient advocates from all walks of life. We need very brilliant students because they push medicine’s frontiers ahead. But we also need caring primary care physicians. And putting them together in medical school will hopefully lead to a dialogue between them.
As I am thinking more about this, I might come up with more ideas. What would you wish to implement in the hospitals of the future? Read More
Blog: On Health. On Writing. On Life. On Everything.
How to Measure Diabetes
July 21, 2010
In ancient times, diabetes was diagnosed by licking the urine of the patient. If it tasted sweet, a diagnosis of diabetes mellitus (“honeysweet flow”) was made. As a physician, I am glad we have advanced to better tests...
There are basically four different tests to diagnose diabetes (I am talking here mostly of type II):
• Spot blood sugar. Since sugars rise and fall depending what and when you ate, this is a very unreliable test.
• Fasting blood sugar. Does only take a bit of blood, is cheap and fast – but still can vary with what one ate the day before. However, if your fasting numbers are up consistently, you should pay attention!
• Oral Glucose Tolerance Test: a complicated procedure where one drinks an awfully sweet fluid before blood will be drawn in half-hour intervals to ascertain how fast the sugar load is cleared out. It’s complicated, and very time-consuming for the patient. I object of giving a patient a drink 75 to 100 gm of unpalatably sweet glucose solution – which can’t be healthy if there is a disease caused by sugar. My suspicion is that this test is still be used because doctors can bill the most for this.
• Glycosylated hemoglobin, also called A1c: An easy blood test that gives a rough average of your sugars through the last month. I like this one the best because the usual ups and downs of sugar are not interfering with the test, but going into the overall measuring. With frequent episodes of hypoglycemia (too low blood sugars), the test might come back falsely low or normal. In iron-deficiency, A1c are higher than they really are, suggesting diabetes where there might be none. Every time one eats sugar, it “glycosylates” (adding a sugar to the molecule) a protein on the surface of an erythrocytes (red blood cells), and the chemical process is never reversed as long as the blood cell lives. Red blood cells live about three months; blood we draw is always a mixture of very young cells, newly released into the bloodstream from the bone marrow, and older cells, soon to be discarded. Measuring blood glycosylation therefore represents a fair mirroring of recent sugar intake and over time, those numbers can be compared: A lower A1c means you have done something right lately.
In conventional medicine, A1c is called normal if it is below 6.0. A1c is measured in percent of how much of the blood is “sugared”. Starting at 6.1, you have diabetes. That in it itself is rather absurd: A little step upward from 5.9 to 6.0 does not give you diabetes – you had it coming all along. In Natural Medicine, we think that between 5.0 and 6.0, one has “latent” (developing) diabetes. Why that number of 6.0? Because if one would chose 5.0 as the cut-off point, most Americans would have to be diagnosed with the disease.
The Oral Glucose Tolerance Test is more sensitive to detect cases of diabetes – but only if the cut-off point for diabetes is set at 6.0 A1c.
Arbitrarily putting the number to 6.0 does not make a person healthier. In fact, at the date of diabetes diagnosis, I good proportion of patients have already end-organ failure, namely eye problems, kidney failure, neuropathy – to name a few.
Just looking around tells us that many people are overweight and have some of the telltale signs of diabetes: belly fat, scant hairs on arms and legs, rosy cheeks. One sign alone does not make the diagnosis – but several together gives me an idea. But one can be very overweight and never develop diabetes, because in order to get the disease, you have to have the genes AND an unfortunate lifestyle.
Don’t think that genes are an excuse. Because diabetes type II does not strike, if one lives frugally. For instance, after World War II in Europe, basically nobody had it (but people died in droves of tuberculosis then…). Ten years later, with ballooning economies and waistlines, diabetes was back.
But you don’t have to starve yourself, to heal diabetes. You need a mixture of moderate movement (walking, swimming, biking – or dancing; whatever you like) and a diet without sugars, white starches and bad fats.
In diabetes drug studies, diabetes often is called “controlled” if the blood sugar stays within the limits if 7.0 to 10.0 A1c. We can be sure that at those numbers the damage done by high sugars is continuing in the body. I personally favor an approach that does not “manage” the patient’s diabetes, but gets rid of it. And in many cases it can be done, with exercise, better nutrition – and determination on the patient’s side. Read More
Syndrome X Everywhere
June 22, 2010
Nearly half of US adults have diabetes, hypertension, or hyper-cholesterolemia - these three conditions make up Syndrome X. Plus, the definition includes a fourth condition, namely “central obesity”: a big belly.
To make the diagnosis does not take a degree from medical school. One can SEE if people are healthy – or unhealthy. Their "love handles" give them away.
In the study, white people were found to have more often only one of the conditions, whereas black and Hispanics were more likely to have two or all three.
Have you ever seen photos of the Thirties? The people look outright … unreal. Slim. We had the Depression then, granted. Barely anybody was fat. As an aside, look at their faces: They also seem happier. America then was hard at work to get itself out of the bad economical times.
Central obesity is what is also called the “apple form”: Extra weight gathers in the middle, as opposed to dragging down the bottom – which is called the “pear form.” For reasons not yet totally understood, the “apple” is the dangerous one. Probably because the “pear” connotes some genetically programmed weight gain, and the “apple” is all – what shall we call it – cultural fat.
Physicians used to think that slab of belly fat just sits there, unmovable, unchanged, forever. Now they have found out that belly fat is extremely active – like a stealth factory churning out secret molecules that make people eat more and build up more fat. That is why belly fat kills.
Slimmer is not a question of beauty but of health. A disclosure: My father was hefty. I loved it. Still love compact people. But it does not make them healthier. It only means that I will go through the heartbreak to lose them earlier – statistically speaking.
Sebastian Kneipp (1821 to 1891), one of my medical heroes, once said: “Big dinners fill coffins.” He knew what he was talking – he carried a paunch himself. Interestingly, he was a vegetarian. He did himself in with dumplings.
Which brings us to food. I will not give you a long lecture about healthy eating. Avoid high fructose corn syrup (HFCS) as a minimum, and stick to vegetables, vegetables, vegetables. Occasionally have some fish and (organic) meat.
We have the best health care system in the world?? Medicine makes us healthy??
We have a disease care system; doctors “manage” diabetes, high blood pressure, lipid abnormalities, and so on, but they don’t cure you. Why should they? They’d lose a patient. So they are going on “managing” your diabetes, high blood pressure, high lipids. If you want health, you have to do it yourself. The old-fashioned way: more sleep, fresher food, cold shower, a daily walk – one step at a time. Read More