Defining a healthcare spectrum

Stepping back, reading this book review prompted me to contemplate and try to define a healthcare spectrum. Respecting the numerous ways in which people make sense of, deal with, and explain their health experiences, I find it useful to think of healthcare in continuous terms, as a spectrum rather than a collection of categories. This complex, though less tractable, healthcare spectrum avoids platonicty ( click here ) - tunneling on tractable structures and categories - by embracing a holistic, ecologically intelligent, view of health and healthcare. If we define healthcare as any action (or non-action) that improves, maintains, or restores a person's health, then we must admit that this definition possesses far-reaching ecological considerations. If we limit our definition of healthcare to actions (or non-actions) that restore health in diseased persons, then we commit our healthcare efforts to reactive, treatment-based medical approaches that restrict our abilities to practice proactive, preventive medicine. Recognizing that prevention is our most powerful tool in medicine, I embrace a holistic view ( click here ) when defining healthcare (primary care represents a very major piece of this whole; despite current trends that indicate otherwise).

Marking the poles of this healthcare spectrum provides a good starting point. Trauma and emergency medicine - life-saving efforts - occupy the high-acuity end of this spectrum. Nutrition choices (buying lettuce for a salad instead of donuts for snacking) and prayer (meditation, more generally) represent two possible (there are many more) actions that indicate the lower bound of this healthcare spectrum. In between these two poles, numerous human endeavors abound, such as exercise, sleep habits, prescription medications, medical diagnoses, conversations with compassionate nurses, and genetics counseling, to name a few. Moreover, this spectrum is not black and white, not fixed nor static; instead, this healthcare spectrum is dynamic and is individualized - some people value prayer more than they value meetings with psychiatrists, for instance. Clearly, embracing this broad definition of healthcare seems messy, but that is the purpose. Maintaining and restoring people's health is a complex, ever-evolving task; defining a healthcare spectrum provides flexibility and fluidity for co-evolution.

Needless to say, in light of Einstein's insights on the relativity of space and time, this healthcare spectrum incorporates how time and space affect the paradox of searching versus acting in medicine. For example, consider a hiker who falls in the wilderness, miles away from a trauma center. This adventurer suffers head trauma and extensive bleeding. Clearly, space and time considerations drive care for this patient. The trauma end of the healthcare spectrum faces considerable space/time constraints, and these limits push physicians and healthcare providers toward the acting edge of the searching versus acting judgment and decision making paradox: trauma surgeons must act quickly to restore and maintain this hiker's health effectively. Now consider the lower bound, the world of choices. Perusing the produce section of a grocery store instead of the pastry section faces little space/time constraints; choices, and thus searching, dominate this low-acuity domain. Therefore, the relativity of space and time help define our healthcare spectrum's landscape - the time alloted for searching before acting in the face of aggressive cancer treatment options differs considerably from the time allowable for searching before deciding whether to have corrective LASIK eye surgery, for instance. The clinical and surgical practices employed by physicians to hedge dynamically against uncertainty vary considerably along this continuous healthcare spectrum as well.

As a practical mental health exercise, I encourage everyone to construct their own personal healthcare spectrums as a way to identify and think about the roles that health decisions play in their lives - try to gain an intuitive sense of your personal healthcare spectrum.