Vital signs are important in medicine. This is fairly common knowledge. If you are unfamiliar with what vital signs are, see an overview of the basic four (or five or six) here.
There are additional elements of data to collect that are not really classified as a vital sign, but are critical in considering one’s health. Here is one example:
Primary care provider: The relationship one has with a primary care provider cannot be mentioned enough times. If you are not familiar with Francis Peabody’s seminal 1927 article in JAMA, please do yourself a favor and read it now.
“Disease in man is never exactly the same as disease in an experimental
animal, for in man the disease at once affects and is affected by what we call the
emotional life. Thus, the physician who attempts to take care of a patient while he
neglects this factor is as unscientific as the investigator who neglects to control all
the conditions that may affect his experiment. The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”
While many wait until they are truly sick to seek out the care of a primary care provider, establishing this relationship in times of health may prove to be more advantageous in the long run.
In the same vein as vital signs, how important is the “primary diagnosis” from the “secondary diagnosis”? In a fee for service healthcare world, having “tiers” of how we address the whole person can lead to pitfalls. For example, what happens if the patient’s primary diagnosis is diabetes but they have some much stress at home they are unable to consider how they can improve their diabetes? Psychosocial “issues” often play a major role in health, but are usually not listed as a primary issue - they are usually relegated to second or third or fourth if at all.
In order to have a more robust healthcare delivery system that is effective, efficient and comprehensive, we have to begin to rethink construct of health and build a system around that new construct that truly meets the needs of the public. Health doesn’t always play be the rules of the system we have built around it. Nowhere is this more evident than the separation of mental health from physical health.
In the current healthcare milieu, there seems to be an opportunity to call attention to these issues. Maybe it is time the healthcare system itself takes its own vital signs and assesses what truly is the primary diagnosis….
- collaborativecare posted this