Six Cardinal Rules when attempting to lose weight and/or reduce the risk of heart and other diseases You MUST take in (eat) less calories than you burn (by exercising and being active) Portion size must be reasonable; do not eat to satiety; try to eat a fair amount of whole grains, fruits, and vegetables, but consume Eat fewer carbohydrates, especially refined and high sugar-loaded ones. Enjoy more polyunsaturated fats (e.g., plant oils and fish). Veer away from low-fat dairy products and nuts.
The Best Available Evidence Does Not Dictate How Medicine is Practiced. In other words, the average patient does not dictate a rule, a protocol or a practice standard.
Curative, Preventive and Now Precision Medicine Will Consider Individual Variability
Approximately 2/5 persons don't understand their insurance coverage, i.e., which healthcare services are being covered under their current plan and, 1 in 5, "have avoided visiting a doctor for a general health concern within the past 12 months because of cost concerns."
The Bio-Psycho-Social, Collaborative Model of Healthcare "It is possible to screen for and treat depression in the primary care setting. Collaborative care for depression can succeed in diverse settings with a range of staffing combinations, patient demographics, and physical layouts. Centralized data support is essential to drive operational workflows and quality improvement across multiple sites."
The cost of health care is already dear and rising exponentially while its "value" or the return on investment diminishes. What can be done?
Healthcare reform is really about managing the care so that it is optimally accessible, reasonable and reliable quality (esp. less variation), and is more efficient and cost-effective. A fellow Medical Director and I wrote in 1994:
The strategic agenda for real reform lies in creating a value-based health care delivery system. As stipulated by Porter and Lee in 2013, health care will be organized and paid for differently in the near future. Six critical steps in reform as as follows [modified]: Separate primary from preventive care; reorganize care around patient medical or surgical conditions, forming what they call “Integrated Practice Units” (essentially team work);
Accountability is the key ingredient in managing and ultimately reforming healthcare.
It's schadenfreude (enjoyment obtained from the troubles of others). That's where I find myself as I observe the surfeit of specialists juxtaposed to a dearth of primary care docs. As Dr. Pauline W. Chen said in "Where Have All the Doctors Gone?"—"I [don’t] envy Mr. Obama.... Any attempt to make health care more accessible will be doomed to failure without an adequate number of primary care physicians and a strong primary care system."