Sunday, September 20, 2009

Heal for America

You've got to be kidding me! I'm sure we all know who will have the honor of being served by this program.


The Teach for America model could work nicely for health care.


Considering the success of Wendy Kopp's Teach for America program—which this year will train and place more than 7,300 highly motivated teachers in our nation's neediest schools—perhaps we're ready for a similar program in health care. Call it Heal for America.

College graduates, it seems to me, would respond favorably to a program that would train and then use them to help diminish some of our shortcomings in clinical care and medical education.

What are some of those shortcomings in care that intelligent and reasonably trained individuals might help with in a patient's home? Understanding of, and compliance with, a physician's orders. Improving cleanliness in homes and helping patients with personal hygiene. Some tasks as simple as proper hand washing are frequently not done for lack of appreciation of how these practices can cut the vectors of disease or lessen their severity. The war on obesity needs to be waged. Adequate sleep explained. Exercise encouraged.

These types of medical suggestions are often made by harried professionals with minimal follow-up. Yet the cumulative effect on a patient's well-being can be enormous. Properly trained members of Heal for America (HFA) could also help cut down on the cost of health care by catching unattended small problems. The need to contact or promptly see medical professionals might be accelerated by a visiting member of the program. In many cases, an expensive emergency room visit might be avoided.

How would it work? Soon-to-graduate or recent graduates of our colleges would be selected following the guidelines of Teach for America—a college diploma from a four-year school, excellent grades, and recommendations from past professors and employers. A one- or two-year commitment would be required.

Once chosen, these young men and women would undergo a short but rigorous training program that would include the recognition of potential health risks. They would also learn to take and understand vital signs (pulse, respirations, temperature and blood pressure). Clearly, a member of HFA could help a patient take the proper dosage of prescribed medicines, and give some advice on preventative health care, such as diet, hygiene and exercise.

It might be useful to think of Heal for America as filling the chinks in the log cabins of some patients' care. There is no substitute for the professional caregiver, but many of us have had suggestions from lay friends that made our lives more comfortable while under professional care, or had a friend or family member make a telephone call to the doctor's office asking to clarify an issue, or one to a pharmacist about a medication.

Of course, the members of this program would not try to be amateur physicians, physician's assistants or substitute registered nurses. Each program would be under the aegis of the county Medical Society and Visiting Nurse Service. No public money, federal or state, would be used. Written approval from the patient or his surrogate would be required before any member of HFA entered a home.

There is a program that could help HFA get up and running. The work of the Visiting Nurses Services has been overwhelmingly beneficial for millions of people under a doctor's care. Perhaps a HFA team could tag along on initial visits and then provide follow-up while the visiting nurse moves on to the next patient. The nurses' reach might be expanded with the appropriate supervision provided. This is not to slight the excellence of other home caregivers, but the need exceeds the supply.

Another area where HFA might be useful would be to work in schools. Nurses in many grade schools only have limited time to teach youngsters about health issues. I don't know how much medical education is being taught in the schools, but perhaps members of HFA could come into classrooms and teach children with hands-on demonstrations, learning materials, and PowerPoint presentations.

Heal for America would also provide valuable experience for college graduates considering a career in medicine. A team member would be more aware of the problems in caring for the sick and the need for innovations at every level of health care—research, clinical, administrative and financial as the population ages.

What about the finances? Who's going to pay for this? My belief is that wealthy individuals and families, specific charities and illness organizations, as well as corporations and foundations will see the potential benefits from a well-run HFA program and contribute tax-exempt dollars.

Regardless of the future of health-care reform in this country, the need for sound medical advice is only going to increase. Physicians and nurses cannot always be counted on to reinforce what was said in the doctor's office or by the pharmacist. Heal for America could.

Dr. Healey is a practicing clinician and former clinical professor of surgery at the University of Texas.

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