Great idea
… and great discussion. Something to think about for the second year of OpenCare. A collaborative map of waiting vs. being given health care and empathy? Nice artifact.
The idea of “rules instead of Hippocratic oath => bad” is intuitively very appealing. I think @teirdes has some structured thoughs and experience.
Also: studying interventions for increased empathy
I would be interested to see if some interventions can trigger more emphatetic treatments and how that affects patient wellbeing. Things like “Hello my name is…” campaign for practitioners to be more humane, or the other day I was reading about inserting empathy in the medical studies - “What Medical Residents Learn from Art Museums”. These things don’t feel too sophisticated things to do for apparently very high returns. We all seem to agree that “more empathetic” is better for patients wellbeing, not just satisfaction which is more obvious.
ask you to try it out
@Natalia Skoczylas, as of the hypothesis of 30% errors in my comment, I understand (and know) the ‘try it out’ stuff. I’ts ok I think. The problem is that as it is extremely valuable information gets lost. Consider two cases:
A: It worked B: It did’nt work.
Was it due to chance or attributed to treatment?
If everybody reported the result systematically it would be easy to identify best treatment. Unfortunately this info gets lost and nobody learns. This leaves it to the bias of where money gets invested for clinical trials. Another reason for a review system.
Yes, you’re right. Although some of my dermatologists I’ve seen plenty of times over years - they just kept on trying things on me, instead of looking for some other reasons why their treatment didn’t work (probably they didn’t address the issue at its core). Anyhow, then I have learned an interesting thing about prescribing people tests. It turns out in Poland each doctor is given a number of tests he can prescribe to people: blood, sugar, more sophisticated ones. BUT, if the doesn’t spend them all, he gets PAID for each test he didn’t give out. Anyway, it’s just one of the pathologies of the system I’ve discovered - as my family is full of doctors, every time I open the discussion I am more and more stunned by how badly it was designed.
I am not enough of a sample I am afraid - I could only bring a couple of stories:)
yep
Thanks, @Alberto. Couldn’t agree more about the conveyer-belt paradigm of mainstream medicine. Acupuncturists who have tried to work in the NHS have been similarly frustrated to the doctors - more, in fact, as their treatment is so individualised.
But as the era of individualised medicine gathers steam, this is something that all forms of healthcare are going to have to grapple with.
2 months is an extremely long time (2 weeks would be more usual). I won’t bore you with the details, but essentially, acupuncturists are licensed at the local level in the UK alongside tattooists and body piercers (which have far greater risks of injury, blood-borne contamination, etc, and are, clearly, not any kind of healthcare) - and are thus entirely at the mercy of whatever inappropriate regulations the district council chooses to impose.
As I said, the knock-on effects are common to any such grassroots community project - but I do think that there is a particular momentum that comes from the project delivering a treatment that directly makes people feel emotionally and physically better;
and, of course, the community clinic model is unique to acupuncture because you can’t treat multiple patients at once with most other modalities!
Can you easily go unnnoticed then?
Hi @steelweaver,
Just to thank you for the contribution and to say I’m intrigued by what it means that you’re operating while waiting for a license, is it dangerous or do you risk anything? Or is it more a matter of time… and you will get it anyway, be in the books etc?
Ever since we heard about the volunteers led clinic in suburban Athens and the potentially many similar ones, it makes you wonder what it is about these grey areas in between formality and informality. Maybe involving people who are not health professionals in the system definition is a requisite for the kind of services you mention - precisely because the ones from the system are too trapped in it to get out alone.
Stepping outside the commercial model
Hi @Noemi,
Well, working on a donation basis was my nod to being a non-commercial entity, which (as far as I know) means the clinic is not subject to licensing - similarly to people who volunteer in hospices, addiction recovery centres etc.
I am conflicted on this - on the one hand, I recognise that some degree of regulation of healthcare is probably desirable to avoid malpractice and protect patients (or at least it was desirable before networked reputation economies became a possibility - who knows what alternative models might be possible now?).
On the other hand, I was certainly struck by the degree to which stepping outside the commercial model of delivery freed me up to do things differently.
It’s also made it far easier to get ‘buy-in’ from the community so that they think of it as something that belongs to them, that they can collaborate with. The terms of interaction defined by our habits of commercial consumption go deep, and having some way to differentiate yourself from it seems very important in encouraging people to thnk and act differently.
So some regulatory framework is needed…
While building trust in the service while ofering affordability and humane treatment is definitely a plus, the questions remains and it’s for us to try to answer in the future looking at stories like yours (which is what OpenCare community essentially does): what happens when a number of such care services become available? We have great insights, yet risk running completely unprotected. The more they grow effective or meet a growing demand, the more attention they draw, the more concurential they become, the more they risk being antagonised by systems on more-or-less valid concerns. Uber being exhibit A…
@markomanka maybe has more interesting insights as to minium criteria which can make health services like these legit from system’s perspective.
Great discussion guys!
@steelweaver, @Noemi, I think you are zeroing in on something important.
Here’s what I’m reading.
All of which is pretty depressing, I must admit. Hope you guys can contradict me 
In my opinion te cases against Uber and Airbnb are valid even if I love the ideas behind them. Uber is getting sued for not providing their drivers with essential support: health care, insurance, repair costs while being free to bring down the prices. And as Google is joining the race, prices will go down. Another problem with Uber is its hunger for monopolizing the markets around - which hopefully will be stopped as well, although this will happen most likely thanks to other giants.
About Airbnb, you are entitled to rent a spare room where you live - the case is against fake sharing, de facto homes and apartments that were emptied so the owners would make money on short term rentals. This changes the landscape of the city and has huge, negative effects.
probably the difference between scaling and monopolizing markets is one of the criteria here. These startups lost the reasonable idea of scale and infringed territories. Hotels and taxi corporation will protect their share and lobby against these companies, which doesn’t need to be good in results. But these battles amplified processes in the urban spaces which could have been happening more quietly before, and that’s good. And made people think about sharing and new ways of the economy. Built trust.
I think the key here is not to let one giant to emerge, but to allow organic replicas to provide similar offers in their environments, without overarching the whole globe with a great huge fix. If the efforts remain decentralized, scattered, but also adapted to local needs and problems, I can’t see a way in which this model would be bad (of course. pharmaceutical companies and other parties interested in ridiculing anything’s that out of the system will try to fight it and there will be a need of great success stories that can be told to the people in order to change their attitudes towards alternative approaches to care. Maybe it’s not even too late, herbal medicine didn’t completely disappear…) or harmful. I believe there should be manuals and ways to ensure people providing help are capable of doing it, however, what kind of manuals and to what extent, I have yet no idea.
Non-profit non-regulated health providers difft from Uber
@Alberto, we should keep your line in mind and mull over it: not scaling as a solution to survivability!
@Natalia_Skoczylas my position is similar to yours: I cant argue in favor of “vulnerable” big companies as long as they do not give back to the community when they can afford to. Ok, they started by differentiation in their business model in that they are not a taxi company, they are a car sharing service. But de facto they operate in the same market except not playing by the same rules as everyone, and taking a route in which they dont make a claim on new and better rules. Or maybe I’m missing that claim. To me, the difference between future clinics such as @steelweaver 's or Helliniko-turned-big and services like UBER is that the former reshape markets to make it better for an overwhealming majority, while the latter just want to stay outside markets for a bigger margin. Yes, they made a contribution in their disruption - I see how bigger the service quality is on the local taxi market where I live and where UBER just arrived, but that’s not enough when they can potentially take more from the community than what they give.
Amen to that
Agree with most everything @Natalia_Skoczylas and @Noemi are saying. The only difference is that I do appreciate that Uber/Airbnb create some value for local communities, by giving some extra freedom to people on the ground. For example, say you notice that there is a long queue for taxis at your local airport on Friday nights. You can then in principle step in as an Uber driver and make yourself availabe for that time slot, if you need the money more than the time. It is a market clearing mechanism, but a clearing market is, in itself, a good thing. What’s bad is a market underpinned by asymmetric power relationships. But we have that anyway: taxi drivers telling people “you can’t work here, this is our turf” is an act of violence. It is no coincidence that most Uber drivers in Brussels are Arabs: plenty of unemployed/underemployed young Arabs in town, and Uber lowers the threshold for them to enter the business. Without it, driving for money is off limits for them. But you have all heard this before, many times.
Evidence based medicine
@steelweaver, this is really interesting. Acupuncture has loong been considered alternative medicine. Lately it has become evidence based. Do you have objective evaluation of the effectiveness of your treatments?
acupuncture evidence
Hi @Rune,
True, acupuncture is largely regarded as ‘alternative’ - at least in the West; it is integrated into mainstream healthcare in China and other East Asian countries, and increasingly in places like Israel and Australia. I would put it a bit differently - it has not been ‘becoming’ evidence-based in the sense of people changing how they practice. It is more a case of practitioners, who have ample experience of the effectiveness of the treatments in their own practices, looking to find ways to produce acceptable evidence to back this up so it will be more widely accepted by the mainstream.
As with all physical interventions, this is not easy! You can’t really run a double-blind control study on a physical therapy where the patient can feel whether it’s being done or not, and a lot of the resistance to accepting acupuncture involves either rejecting all the ‘lesser’ forms of evidence for its effectiveness, or designing ‘sham’ studies that don’t really take into account how acupuncture works.
All that said, there is still a lot of evidence for its effectiveness for a variety of conditions. The Acupuncture Now Foundation have an accessible summary here: https://acupuncturenowfoundation.org/wp-content/uploads/2016/05/ANFwhitepaper2016.pdf
Or you can look at their research page - https://acupuncturenowfoundation.org/doctors/studies/ - or at the factsheets on the BAcC website: http://www.acupuncture.org.uk/category/a-to-z-of-conditions/a-to-z-of-conditions.html
I have Chinese colleagues who like to point out that this is just the tip of the iceberg - there are literally thousands of positive studies from China [and Japan, and Taiwan, and South Korea, if you’re worried about the quality of communist science] that have never been translated into English…
I don’t have any evidence of the effectiveness of my own treatments specifically, though! I can’t afford to hire a medical research team, so I’m reliant on the already-existing body of evidence and theory.
EBM
Dear @steelweaver, I do appreciate your references, but cochrane reviews are better in supporting the statements. Personally I have proposed some studies but apparently ‘scientific approach’ is disturbing the ‘chi’. However we surrender to a universal law ‘effectiveness is the measure of truth’ and we have a moral obligation to strive for the most effective treatment (leave the measure of effectiveness open for now) regardless of our personal beliefs, hopes and dreams.
What I’m getting at here is that OpenCare should also consider establish a serious approach with double scope: avoiding infiltration of quackery and protect us from accusations of quackery.
What I’m asking the community for is to contribute with ideas of how to implement EBM in our approach, as in your clinic?
What I think we can offer each other within OpenCare is the solution to “can’t afford to hire a medical research team”, surely we have the skills in this comunity.
So lets help each other. I’ve started a cook book over here
Insight?
I’m not familiar with the project and do not really immiedetly see what my contributon should be. References to previous insights on how private services are more customer oriented than public?
Stealth mode
No, other examples of care services that rewire themselves so as to (1) establish themselves as “owned” by the community and (2) bypass stifling regulation.
traumatapping
@steelweaver, as an acupuncturist, do you know this tapping technique: Trauma Tapping Technique, TTT - a tool to resolve ptsd | Peaceful Heart Network and do you think it is effective?
tapping
I haven’t come across that exact technique - a quick google suggests it is a modified version of EFT suitable for people with more acute trauma.
What I have heard from colleagues [and here] is that these tapping techniques work, but mostly because the tapping helps to distract/reorient the system to allow the trauma to be released, rather than because it is a specifically effective sequence of acupuncture points.
That said, acupuncture points are areas that initiate particularly high physiological responses, so if you are going to be tapping yourself, arguably you might as well do it on acupuncture points to get an even better effect. And doing a sequence of points in all the areas of the body will ensure that no forgotten area retains the tension of the trauma.
In short - it’s probably worth giving it a try!