the-lancet---culture-and-health.pdf

Clinical cultures should be reshaped caregivers

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Clinical cultures should be reshaped Caregivers cannot improve patient wellbeing in the long term if they cannot develop cultures of care. Clinical systems should be redesigned to cultivate social engage- ment between caregivers and patients, and between caregivers’ and patients’ cultures (such as advocacy groups). These new forms of engagement should develop in conjunction with local provision cultures. Such a redesign could take the form of a reconfi gured medical home for patients, but the eff ectiveness of any reconfi guration should not only be measured in terms of clinical outcomes. Eff ectiveness is equally dependent on functional outcomes and patient satisfaction. To encourage behaviour change, people need to work together across cultures of care. Expensive procedures and management cultures should be discouraged so that money can be spent on actual care. The cost–benefi t of such a transformation should be measured to shift the emphasis of health care from for-profi t activities to caring ones. Local communities need to generate cultures of care that are focused on solutions rather than problems. Behaviour change should extend not only to a focus on prevention, but also to the re-education of science and business establishments about the value of research into cultures of care. Aff ect should be considered an important infl uence on health, with positive aff ect being something to strive for. To spend scarce resources on more oversight rather than provision will exacerbate the impotence of health-care systems worldwide to create positive change. People who are not healthy should be recapacitated within the culture of biomedicine Because non-adherence often results from an absence of capability from patients, clinical practices should be modified for those in need, rather than marketed to the wealthy. When patients lack ability, they become disproportionately incapable of participating in their own improvement, meaning that the cost of caring does not rise proportionately for those with resources, but it does rise substantially for society. Profit making should not be assumed to encompass altruism because the two are not always compatible. Building trust should become a major focus of health-care policy. The long-term costs of short-term financial decisions on health should be replaced by the study of how health care can be reshaped to make both behaviour change and wellbeing its central focus. When public organisations mask private gain, those who would otherwise contribute to the public good lose trust in collective action and turn instead to strategies for improving self-worth. When resources are limited, self- worth loses its collective and cooperative meaning, invariably becoming self-centred. Health care cannot continue as the most profitable industry in local economies, and limits should be placed on the predatory nature of medical profiteering on the backs of the weak and vulnerable.
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