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NATIONAL HEALTH

"It's better for everybody when it gets better for everybody." Eleanor Roosevelt

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* PREFACE

 

w h a t     i f

       

 

 

 

 

P  R  E  F  A  C  E

                      

                         

                   

 

 

 

 

 

INTRODUCTION        

 

 

” You  will  write,  if  you  will  write,

without  thinking  of  the  result  in  terms  of  a  result,

but  think  of  the  writing  in  terms  of  discovery,

which  is  to  say  the  creation  must  take  place

between  the  pen  and  the  paper,

not  before  in  a  thought  or  afterwards  in  a  recasting.

Yes,  before  in  a  thought,  but  not  in  careful  thinking.

It  will  come  if  it  is  there  and  if  you  will  let  it  come. “

“Writing  is  the  only  thing  that,  when  I  do  it,

I  don’t  feel  I  should  be  doing  something  else.”

Gertrude  Stein      (  1874  –  1946  )

       

       

PERSONAL  ANGST 

              

Before retirement in 2016, I was a Primary Physician and belonged to a small, group practice along with two other physicians and a nurse practitioner.  Our group started in 1975 and closed  41  years later. Its street address had moved  10  blocks west in 1992. Both locations were less than  1/2  mile from the northwest edge of the city in 1975.  By 2016, the nearly unchanged location of our office was near the geographic center of Omaha.

Thirty years before closing, our practice added  20-30  newborns a month.  During the last  5  years, we offered our Primary Healthcare to about  3  newborns a year.  These changes represent a snapshot of our practice during its  41 years.  In spite of the demographic changes, the total number of active patients had been stable from year to year, variably around  2,500.  For us, an active patient is someone who had been seen for at least one office encounter within the previous  18  months.  The number of people who are seen once, never to return, are nearly equal to the number of people who are seen once every two to three years.

During my career, I have been saddened by the governance deficiencies within our nation’s healthcare industry.  But to a larger degree, I have been especially saddened by the concerns and frustrations of our patients as they experience their healthcare.  These concerns represent the aspirations of our patients who had individually invested in their HEALTH  with our practice for extended periods of time.  Many of these patients, maybe 2/3,  were members of families with a connection with our office for more than  30 years.  Above all else, I dedicate any value of this Blog to these families as a recognition of their contribution to the  therapeutic  community  of our office.

It is my hope that each citizen and every Primary Physician could experience the privilege of contributing to a similar therapeutic community.  Eventually, healthcare reform should create the basis for a continuously adapting healthcare industry.  This reform process should assure that each citizen has a caring relationship with a Primary Physician associated with enhanced Primary Healthcare.  I invite you to share my belief that this Blog describes a possible means to this end, community by community.

            

WHY  NOW !

               

The initial impetus for this Blog occurred in 2007.  In November of 2007, I attended a ‘community lecture’ here in Omaha by Henry Aaron, Ph.D., an economist with the Brookings Institute in Washington, D.C.  His projections for the future ‘health spending’ for our nation’s healthcare led me to one conclusion.  The future cost of our nation’s healthcare industry could not be sustained by our nation’s economy.  So in 2008, it was time for me to learn more.  I wrote several short essays for myself about healthcare reform thru 2009, the first represented by the   FIVE  HEALTH  STORIES   Sub-Page of the  APPENDIX   Page.

Soon, my search for information and new ideas began to a assume its own momentum.  Eventually, I began to perceive that a solution, based on old ideas newly revisited, could unlock the paradigm paralysis afflicting our nation’s healthcare industry.  This Blog first appeared in November of 2008.  It is now regularly revised, usually in fitful spurts.  Over and over, my experience with this Blog affirms the view of Gertrude Stein about writing. For me, she was and continues to be correct.

        

Paul Nelson,  M.D.

Omaha

 

P. S. :  The ubiquitous stethoscope, shown above, became  200  year-old technology in 2019.  For perspective, blood pressure measurement using a sphygmomanometer,  viz blood pressure cuff, originated in 1881.  Only the thermometer is older, about 1617.  Considering the measurement of time, the century of about 1500 B.C. seems to be the consensus for its origin.  

I vote for a new test that would accurately assess a person’s capability for stable homeostasis at any given point in time during a person’s life.  How about 2025 as a goal date?  HINT: The test will probably be reported in real time using the format of a Fourier transform.

 

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