For the last 30 years, at the Lincoln Recovery Center in the Bronx, Dr. Michael O. Smith has managed a successful drug detoxification program that relies on ear acupuncture as its primary medical modality. In the 1970’s the program was geared entirely towards heroin addicts that had made their way into the Methadone maintenance clinic. Through trial and error Dr. Smith, who is both an MD and a certified acupuncturist, and his colleagues, discovered that the daily insertion of five acupuncture needles in each ear for about 45 minutes achieved results similar to what the addicts experienced in the Methadone maintenance clinic. In the past twenty years, Dr. Smith has brought the solution, known as the NADA (National Acupuncture Detoxification Association) Protocol around the world. The protocol is used on all prison inmates in Great Britain. In fact, more than 1500 clinical sites in the US, Europe, Australia and the Caribbean currently use these acupuncture protocols as an adjunctive treatment for addictions and mental disorders.

As part of my own study of integrative medicine in America, I spent the month of July learning the NADA protocol from Dr. Smith and his staff. Over 7,000 mental health and acupuncture professionals have been trained at Lincoln Recovery Center over the years. The training, which takes approximately two weeks, is streamlined, focused, and involves a peer teaching component with feedback and quality control mechanisms. During my training period, I met individuals from Denmark and England who traveled to the U.S. just to be trained in the protocol. After we completed our initial training, we treated patients who showed up, religiously each day, to receive their ear acupuncture. The clinic consists of about 80 comfortable, high backed chairs lined up, one next to the other. Patients check in, grab an alcohol pack, take an empty seat, and swab their ears clean. Once they have cleaned their ears, they raise a hand and the next available acupuncturist makes his way over to quickly insert the five needles in each ear. This process takes about 3 minutes. Then, in the quiet of the room, the patients rest their heads on the back of the chair, most close their eyes and meditate or sleep, though some read. After about 45 minutes have passed, the patient raises his hand. An acupuncturist hands the patient some gauze, removes the needles, and the patient is free to leave – until tomorrow, when the process is repeated again – all in the name of remaining drug-free.

What I experienced during my training at the Lincoln Recovery Center was not only an effective treatment for addictions, but also a process that empowered the individual to become responsible for himself and his actions – perhaps going to the true root of an addiction. Everyone of these patients showed up willingly, participated in their own care (when was the last time a nurse asked you to swab your arm before drawing blood for a test?), and took ownership of the process and of their own actions.

Here’s the kicker…..given the streamlined training, medical supervision component (at least as it is administered in New York state), and number of people that can be treated concurrently, it is estimated that the cost for this service is about one dollar per person per treatment, or about 300 dollars a year. The effectiveness of this treatment has been proven in over 30 years in over 1500 clinical sites in over 25 countries. Yet, here in the US, the country of the NADA protocol’s origin, health insurance does not pay for this service. In fact, in some states, the protocol is not permitted to be administered at all. If decreasing illegal drug use, decreasing the cost of care, increasing patients’ responsibility for their own care, and increasing the effectiveness of care all while using safe (low risk) modalities are goals of health (or health insurance) reform, shouldn’t modalities like NADA be acknowledged, used and for God’s sake paid for? For more on NADA, the non-profit association, see www.acudetox.com .

Sam, a 70 year old healthy man, sat on the table in his urologist’s office for his one year follow up visit. Twelve months prior to this visit, Sam had bladder stones and an enlarged prostate. Dr. Rosenthal, his urologist, removed the stones and some prostate tissue during a hospital-based outpatient surgery. The surgery went well, and during the two-week follow up visit, Dr. Rosenthal informed Sam that he would not need to see him again for a year. One year later, as Dr. Rosenthal walked into the exam room eyeing Sam’s medical record he stopped for a moment, raised his eyebrows and then looked sheepishly at Sam. “I’m sorry,” he said, “the pathology report from your surgery showed prostate cancer. And, I am afraid I did not see the report until now.” Sam was confused as to how that could have happened. Although he had not previously requested a copy of the report, he asked for one now. After calming down, finding a new urologist, and making plans for the testing to find out how far the cancer had spread over the past year, Sam finally sat down and read the report. Typed in large, bold type across the top of the report was the following statement: “Results telephoned in to Dr. Rosenthal on 05/05/08″…..one year prior to the visit. Turns out not only did Dr. Rosenthal have a copy of the report, he also had received a verbal notification that Sam’s pathology report showed cancer of the prostate. The hospital had a strict policy of calling the surgeon, in addition to faxing and mailing a copy of the report whenever there was a finding of cancer. Sam’s story is one case – what happened here may not be common place, but it does occur. Although we may not think it’s our responsibility to read our operative report or a pathology report, incompetent physicians and medical malpractice claims aside, it could mean the difference between a good or bad result in the best case scenario, or life and death in the worst case scenario. In the end, your health information is just that…..yours. No one will care more about it, or own it, in quite the same way as you.

According to the Healthcare Information Management and Systems Society less than 1 percent (0.1%) of hospitals have a paperless shared electronic health record (EHR). Although almost 67 percent of hospitals have some degree of EHR in place, few have a system that allows patients and their physicians unfettered (but yet protected) access to essential, often crucial information about the patient’s health status. The Obama administration’s plan to fund EHR activities is a positive move towards making the universal EHR a national standard. However, given the current lack of adequate preparedness of most healthcare providers, the goal is unlikely to be accomplished before President Obama completes his second term in office. For the average healthcare consumer, the message is to act now on obtaining their health information and keeping it in an electronic format to be shared with all providers who treat you. The personal health record (PHR) is not a substitute for the EHR, but it does fill a gap. More importantly, it empowers each of us, as patients, in having control and knowledge over an essential part of our healthcare. Today, it is our responsibility to make sure that all of our healthcare providers have the information they need to provide us with the best possible healthcare. Except in highly integrated systems like Cleveland Clinic or the Mayo Clinic, we cannot assume that a specialist has access to information from our primary care visits. At least for now, that’s the patient’s responsibility…….

In 1997, the results of a psychological study of nursing home residents were published.[1] 91 residents were split into three groups. The first group received a speech from the director of the home emphasizing that the residents had a lot of responsibility for their own lives. She also told them that a movie would be shown on two nights during the upcoming week and that the residents had to decide on which night they would attend. The director gave each resident a house plant, stating that it was up to the resident to take care of it. The director also gave a speech to the other (comparison) group, but she omitted all references of taking responsibility and making decisions for themselves. This group was assigned to a movie night, and each person was also given a plant. However, this group was told that a nurse would care for the plant. The final group was assigned a movie night and had no speech or plant given to them, just business as usual in the nursing home for them.

When the researchers conducted a follow up study 18 months later, they found that the intervention not only improved residents’ health but reduced the likelihood that they would die. After 18 months, 15 percent of the experimental group had died compared with 30 percent in the comparison group. The findings suggest that giving elderly people more responsibility and control over their lives and their environment may slow down mental and physical decline. More importantly, there are possible implications for every one, regardless of age. Not being actively involved in the decision making about your life and your day-to-day activities can have a detrimental effect on your health and well-being. The converse, being more aware, mindful and engaged in decision making about your life, and more importantly, about your health can have a positive effect on your health and well-being.

House Resolution 406, a call from Congress to incorporate Wellness programs into the American health care system was introduced at the end of last term, and has been introduced without further action every year for the past 4 years. You can see the text and track the status of the current resolution here.  Under the Obama administration, there is a greater likelihood now more than ever that wellness legislation will become a reality.  Why wait another day? We can all take action for the sake of our own wellness.

10 Things you can do for yourself to improve your health:

1. Breathe deeply & slowly
2. Create your vision for your health
3. Eat more greens and less sugar
4. Drink more water and less caffeine
5. Move your body in a new way; try yoga or tai chi
6. Get in touch with your body; try massage
7. Rest your mind; try meditation
8. Laugh; look for humor
9. Learn something new every day
10. Sun yourself from outside as well as the inside

Childhood obesity accounts for about 9 million children in the U.S. A series of social, economic and environmental changes have occurred over the past few decades contributing to childhood obesity. As a society, we have reacted to those changes, but we have not managed our reactions. Some argue that the root of our nutritional problems began with the Regan administration’s encouragement of Wall Street rewarding firms for hitting short term gains, regardless of the methodology used to get there. The processing, refinement and other adulterations that lengthen the shelf life and decrease the nutritional value of food, and add calories and weight are largely a result of this economic policy. Also contributing to the obesity epidemic is the fact that on average, a child watches 4 hours of TV, spends one hour using a computer, and 49 minutes playing video games per day.

If childhood obesity  is rooted in mindless choices, then mindfulness may be the first step for each of us , to take. Making thoughtful, healthful decisions in our nutritional choices is a first step towards mindfully managing our reaction to stress and change Let’s make food decisions based primarily on their impact on the mental, emotional and physical impact they have on us, and not primarily on their economic impact. Take the “Vision for California” example, which includes a Ten Steps Towards Healthy Living statement for every Californian. You can view the statement at  http://www.cnr.berkeley.edu/cwh/PDFs/Summit_Governors_Vision.pdf. If, like the IOM said in 2005, “the prevention of obesity in children and youth should be a national public health priority”, then we need national-level marketing about the issue as well as action. Instead of a vision for California, what about a vision for the USA? The obesity epidemic is deserving of marketing at the level of the anti-smoking campaigns funded by the tobacco companies as part of their class action settlements. Healthy people, and in the case of childhood obesity, healthy future generations lay the groundwork for a healthy nation. The time for collective action, for each of us individually and for society as a whole, is now.

The phrase, Medicalization of Life refers to “society’s growing trend to classify more and more life problems as medical problems” and treating those problems with pharmaceutial or surgical intervention. Many advertisements describe how to treat problems like restless leg syndrome, sexual dysfunction and insomnia with a physician visit and a prescription drug.  These are examples of medicalization of life issues today that, 20 years ago, we did not even have a medical diagnosis for, let alone a treatment.  Determining the proper level of medicalization involves asking questions such as, when does a deviation from normal need medical intervention? and, what are appropriate alternative treatments?  Medicalization speaks to an issue of fear – fear that society continues to lower the bar in defining what is a disease and in need of medical treament.  Achieving a balance in the growth of medicalization requires a group effort:  proactivity on the part of the patients, open mindedness from treating physicians, and information, education and research support from the government.

One task for the new administration will be to turn our healthcare rights into reality. Just as he was able to unite us on election night, President-elect Obama should unite us all through equal rights in healthcare. In America, healthcare is only considered a “right” for certain classes of individuals, including those over 65, those with certain diseases, and those with either enough money or not enough money. However, once you become a patient, regardless of your ability to pay, you have additional rights guaranteed to you – at least on paper. And yes, because we are America, our rights come along with additional responsibilities as well. Problem is, it’s not clear that we are even all aware of these rights and responsibilities. A good place to start is by communicating and informing.

Our healthcare rights are published in the Patient’s Bill of Rights and Responsibilities, but even this did not happen until 1998. The bill gives us the right to accurate and easily understood information to help us make informed decisions about our healthcare. We also have the right to choose our provider, access to emergency services, care without discrimination, privacy, speedy complaint resolution. We also have the right and the responsibility to be a full partner in our healthcare decisions. The bill also states that patients must also take greater responsibility for maintaining good health.

While the Obama administration has a long road ahead in many areas, including healthcare, we all have a key role to play as well. If we go back to the original objectives of the Patient’s Bill of Rights, it may provide both us, as healthcare consumers, and the new administration some initial guidance. The original objectives of the bill were to:

· Strengthen consumer confidence by assuring the healthcare system is fair and responsive to consumer’s needs

· Encourage consumers to take an active role in improving and assuring their health

· Reaffirm the importance of a strong relationship between patients and their healthcare professionals

· Reaffirm the critical role consumes play in safeguarding their own health by establishing both rights and responsibilities for all participants in improving healthcare status.

St. Luke’s Hospital in Bethlehem, Pennsylvania was recently featured in an article in the local paper. The article reads, “St. Luke’s Hospital is so confident in its surgeons’ ability to perform successful robotic prostate surgery that the hospital is taking the unusual step of offering a limited money-back guarantee. Under the guarantee, patients and their insurance companies will not be billed if complications from robotic prostate surgery arise within 30 days.”

This is the kind of patient-centered service all hospitals should consider offering to some degree. All healthcare outcomes can’t be guaranteed – and, just like any other guarantee, this one comes with its fine print and limitations. But the point here is that this is a revolutionary step for healthcare providers. And, certainly a positive step for patients – especially patients of St. Luke’s Hospital and others like it. Although it appears that St. Luke’s is the only hospital currently offering this kind of guarantee, chances are other patient-centered hospitals will follow suit.

On a personal note, my father recently had surgery at St. Luke’s Hospital. The care and treatment was superior – based on experiences we have had at other hospitals. Besides the excellent bedside manner from the surgeon and all of the nursing staff, my father’s outcomes were good. Check out a few of the perks: no limitations on visiting hours; you can order food at any time and get it within a short time; a beverage cart team that comes to patient’s door a few times a day and offers beverages to the patient and his visitors; coupons for a percentage off any food purchased by the patient’s family in the cafeteria or hospital restaurant. But in all honesty, the best feature of this organization is its people. I felt like they were trained by the same people who train the staff at the Ritz Carlton – plus these folks were all clinical or operational healthcare experts. This is what we should expect – and get – in our healthcare every day. Good service, good people, good outcomes – all put the patient in a good mood. And, it all adds up to the true definition of high quality healthcare.

Most of us today spend more time planning a party or buying a car than we do planning our healthcare. Granted, it is not as pleasant to create a plan for our healthcare as it is to picture ourselves behind the wheel of a new Mercedes or BMW, but the stakes are certainly much higher. And, chances are great that if we are proactive and make decisions before we need medical attention, if and when we do need care, our outcomes will be better. While not a sure-fire guarantee of a positive result, when you are invested in an outcome chances are better that your outcome will be a positive one.

Whether by design or not, the passage of HIPAA and the Patient’s Bill of Rights at the turn of the Century kicked off a series of events that has begun to cause a shift in the level of responsibility many of us are taking for our own healthcare. Continued support for HIPAA and HIPAA-like laws and regulations will likely continue this trend. HIPAA clearly spells out certain patient rights in their health information. Among them are your rights to obtain and inspect a copy of your medical records and to request a correction of inaccurate health information. Among a patient’s rights as spelled out in the Medicare Patients’ Bill of Rights are the right to choose your healthcare provider (remember when your Primary Care Physician used to be assigned by some healthcare plans?) and the right to fully participate in all decisions related to your healthcare.

Hospitals have taken these concepts a step further and have created their own Patients’ Bill of Rights that give patients the right to know if your providers are in training, request a second opinion or change physicians, receive a copy of your bill and have it explained to you, and the right to financial counseling as well as others.

In the legal profession, we have seen a shift in the concerns and claims brought to us by clients. For example, in the past year alone, we have counseled several clients who had complaints about the content of their medical record. In two of the cases, the patients had brought their records to the providers and asked for clarification and some type of change since they disagreed with factual statements in the record. When the providers refused, the patients sought legal counsel. While we don’t see this as a growing area for legal services, we do see it as a way to educate and inform both patients and providers. More importantly, we see this as a positive sign that patients are paying attention to the details of the law that impact them and are acting on it.

Exercising greater responsibility in healthcare planning and decision making not only benefits the patient, but also makes the provider more accountable. The end result is higher quality of care and lower costs – something we can always use more of!