HEALTH SYSTEMS AND THE LAWS OF THERMODYNAMICS

  Health systems are social and living systems

• Social and living systems are networked and highly nonlinear

• Such systems are governed by the laws of thermodynamics

• Power is work ( energy expenditure ) per time- unit

• Endurance capacity of man and his health systems is determined by the factor of

the " effort " that can be resumed to discomfort in the form of "fatigue" .

• Zeroth Law of Thermodynamics : If a system A (service provider ) is in thermal equilibrium to a system B ( service consumer ) and B ( service consumer) to a system C ( service financier ) , then also A (service provider ) is in balance with C ( service financier ) . The state quantity , which is coincident within these systems is the temperature ( the higher the temperature of a body , the larger is the average speed rate of its particles )

• First law of thermodynamics : The energy of a closed system (human, health systems ) remains unchanged. Various forms of energy can therefore interconvert , but energy can neither be created out of nothing , nor can it be destroyed. No system does work without supplying any other form of energy and / or without reducing its internal energy.

• Second law of thermodynamics : heat can not pass by itself from a lower body temperature ( lower rate of speed of its particles ) to a body of higher temperature ( higher speed rate of its particles). For example, heat can not pass by itself from  service providers to more and more demanding service consumers. Or: heat can not pass by itself from service consumers to increasingly demanding service financier ( insurances ). The inflation spiral and cranking the economy needs energy.

• Third law of thermodynamics : it is not possible to cool a system to the temperature of absolute zero. A person , or a health care system can not  be cooled to absolute zero . ( its particle velocity magnitude is zero )

• From all that follows that one-sided money exploitation and profit maximation of the health systems through the financial industry while ignoring the laws of thermodynamics leads to overheating and burning out of people, to non-renewable yield of the energy content and reserves of the systems and to the eventual collapse of the health systems.

WORKING GROUP ON LINKEDIN

This working group has extended its activity by creating a group on www.linkedin.com health professionals'health

ITINERARY TO BURNOUT IN HEALTH PROFESSIONALS

Definition : burnout is

1.    an experience of physical, emotional and mental exhaustion, caused by long-term involvement in situations that are emotionally demanding.

2.    The index of dislocation between what people are and what they have to do. It represents an erosion in values, dignity, spirit and will and erosion of the human soul.

Manifestation :

1.    Emotional exhaution

2.    Depersonalisation

3.    Lack of personal accomplishment

Itinerary to burnout

Motivation to study medicine:

Humanistic values and ethics are the main motivators for students in medicine. During medical training there is still insufficient focus on health aspects in the health systems concerning health professionals. There is insufficient training in conflict - management, business management, team-work and job-sharing. There is insufficiency in intervisions and supervisions.

Once finishes university training the young doctors are exposed to :

1. daily contact with illness, pain and death

2. excessive work load

3. increasing lack of social support ore even hostilities and 
    attacks increasing ( 20% in 10 years ) in a context of 
    feminisation of medical profession.

4. often working with colleagues who suffer already burnout 
    síndrome

5. excessive bureaucratic load

6. increasing penetration of health systems by the market 
    society and its beliefs

confronted to that reality young doctors with their humanistic motivations and ideals too often enter into the process of burnout which goes through the following phases :

1. phase of illusion and enthusiasm

2. phase of dis-illusionment and disappointment

3. phase of profound frustration

4. phase of despair then falling apart and getting sick 
    or entering the following phases

5. phase of cynisme and detachment

6. phase of making money

7. phase of being eaten up by the market society

In the sake of healthy health systems, of healthy health professionals, of quality of care, of cost-effectiveness, of patient security, of motivated future young doctors and last but not least healthy society, the following preventive mesures are a must, whereby continuity of the process is of paramount importance.

1. redefinition of health professions in the context of 
    society and social security systems

2. systematic and continued analysis, identification and 
    updating of health aspects in health systems

2. structuring multiprofessional care-teams

3. prevention and assessment concerning burnout risks

4. training of health professionals in social competence 
    and networking

5. training in conflict - management

6. training in management of change ( change as an 
    opportunity rather than a threat )

7. intervention of trained coaches in health systems

8. intervision and supervision for health professionals

9. tutoring of medical students

10. enhancing job-sharing for a better job-family balance

11. enhancing personal development plan to foster 
      personal growth

12. training in human sciences

  

Health of Spanish Health Professionals 

attacked by a highly disfunctional health system

Due to a highly disfunctional health system, characterized by the absence of professional development reducing health professionals to simple civil servants and executors of state- dictated labour rules and on the other side characterized by insurance-dictated miserable contract conditions, Spanish Health Professionals suffer the highest rate of burnout syndrome in Europe. Research shows rates of 35-85% of Health Professionals presenting serious signs of burnout syndrome. Consequently over 10'000 doctors already emigrated to other countries in search of respect, dignity and human work conditions. Considering that a medical training costs the society about 200'000 € this loss of physicians represent a destruction of capital of 2000'000'000 ( 2bn € ). SWISSpsy in collaboration with ASPROMEL ( Spanish Professional Association of Doctors in free practice ) insist on health aspects in health systems being an absolute priority to garantee sustainable health systems and secure health care.  

5-D Application for health systems and for health professionals'health

 5-D application for health systems

and for health professionals' health

5-D ( five-dimensional ) endoscopy and navigation technology for psychiatry, psychotherapy, therapeutic coaching and psychosomatic medicine.

Abstract

Background : The concept of health is defined according to WHO as a psycho-somatic-social wellbeing. Each of these three fields has developed in medicine,  the sector’s own diagnosis, therapy and forecasting processes. A cross-sector understanding and for the healing process essential integration often proves difficult in the absence of an integrated navigation system.

Objective : To close this gap and thus to provide the practitioner and the patient orientation, support, quality and safety, our institute aimed to develop, according to the WHO definition of health, an integrated navigation system, that should allow sharp diagnostic, therapeutic and forecasting processes in all three areas simultaneously.

Issue : We asked ourselves whether, how and what of  already existing technologies would be possible to integrate into such a navigation system, and how, where and when each of the technologies should come into play.

Procedure : We assumed that this would be best achieved if we started with our own field, the mental one, developed the dimensions one after another, matching relationships between them and proceded only in a second step to the next field, namely the somatic one, integrating it to the multi-dimensional structure of the mental health. From our long experience we knew that the human psyche as the human body is three dimensional, but we had up to then not named the tree axes and not attributed to diagnostic and therapeutic techniques, and above all we did not have the axes assembled together.

In a third phase, we would join the three social axes to our 3-D navigation system.  As an illustrative model, we would use the cube model.

Description : The mental cube consists of axis 1 ( horizontal ) on which we move from left to right, along the time evolution and maturity with its distinctive phases ( autistic, symbiotic, paranoid, schizoid, altruistic-narcisstisic, selfish-narcissistic, borderline, and last of all to the far right, the phase of internal object constancy ). Diagnostically to guide us along this axis are the classifications according to J.F.Masterson, the diagnostic manuals ICD and DSM, as well as classifications from developmental psychology.

Axis 2 ( vertical ) shows from bottom to top the level of awareness that a person has about his or her mental health and developmental situation. Diagnostically and therapeutically  Psychoanalysis and Psychoanalytic Psychotherapy will guide us on this axis.

Axis 3 ( horizontal perspective ) is the kind of focus that a person can set on the various issues of development. Diagnostically and therapeutically we are here in the field of cognitive behavioral therapy and neuro linguistic programming NLP. Now, this 3-D navigation system is for both the patient and for the therapist. Both are to each other in a therapeutic relationship, what constitutes Axis 4 ( type of bond or attachment ) . On this axis we are diagnostically and therapeutically in the field of object attachment theory, with techniques of M.Mahler, Ainsworth, M. Balint, J.F. Masterson and others. This axis 4 is our real endoscope, through which we can perceive where the patient stands on the various three axis. Through this we also  introduce our psychotherapeutic and coaching techniques and control how and where the effect of the intervention took place. This is very similar to the surgical endoscopy. Prerequisite of this technique is that the therapist knows his own axes and dimensions perfectly.

The somatic cube  consists of : axis 1 ( horizontal ) from left to right, the somatic evolution of the person. Here we are in the field of embryology and anatomy. Axis 2 ( vertical ) from bottom to top, expresses the physiology of the human body. Here we are in the physiological control-loops. Axis 3 ( depth ) represents the chemical focus of the body. Here we are in the field of endocrinology and pharmacology. Axis 4 ( type of attachment ) expresses the physical coming into contact with another body. This includes also with inanimate bodies.

The social cube in turn consists of : axis 1 ( horizontal ) the phases of social development of the person with its known phases ( intrauterine, birth, infancy, early childhood etc until death ). Here we are in the range of descriptive developmental psychology. Axis 2 ( vertically ) from bottom to top, the depth of the social roots. Here we are in the field of sociology and education. Axis 3 ( focussing ) reflects the social focus of the person in life. This is the field of meaningfulness of life, of religiosity and of ethics, as well as philosophy.

Axis 5 is more tan an axis, it is rather a dimension, namely the superposition of the psychological, somatic and social cube. On this fifth dimension, the WHO’s definition of health  is based. Here it becomes clear how und where any health problem is located and how it is diagnosed and treated according to the WHO’s definition.

Basic assumptions : Illness is for us not defined as presence of one or more symptoms, and personality disorder is not defined for us as a collection of certain personality traits. What characterizes disease, is getting stuck in a phase of development or a collection of symptoms. This means for people always a loss of inner freedom, on each of the four axes and also in the 5th dimension. The loss of inner freedom and entanglement in useless attemps to break out or to compensate     are what make people sick.

Technology : Both , diagnosis and  treatment, make use of the endoscope, i.e. the axis 4. By best knowledge of his own axes and dimensions  the practicioner becomes an expert in the illumination of the different axes of the patient. Through his years of training and refinement of the intervention technique, he is an expert in medical psychotherapy, psychiatry and psychosomatic medicine. Each of the axes requires a specific technology that must be mastered, and they are specifically tuned to the phases on axis 1. Inappropriate technique can lead to iatrogenic injury. Advanced technical skills are an integral part of this 5-D endoscopy and navigation system. On the other hand, precisely because of this system, accumulated technical errors are detected immediately and razor-sharp and corrected.

Benefits : Thanks to this 5-D endoscopy and navigation technology  disorders with a character of illness can be differentiated from those without. This allows to do either therapy with the consequent funding by health insurance, or coaching for further personality development, with the consequent funding from other sources. The concept of health by the WHO is applied with this technique in each individual intervention.

Results : In the four years we have used specific and daily this technique, we observed the following : faster and more accurate diagnosis and treatment, lower session frequency, shorter total duration, transparency and quality, increased safety for both patient and therapist, lower overall costs, no double – diagnoses and treatments, no treatment interruptions, flowing transition from therapy to coaching with a clear differentiation of the respective funding sources, rapid social reintegration, very low rate of chronicity. These results were confirmed repeatedly by the patients, the relatives and the referring physicians and institutions.

Conclusion : Since four years we are working at our institution with a 5-D Endoscopy and Navigation Technology that is simple and straightforward, which is tailored to the human structure, which is from a diagnostic and technical point of view  razor-sharp, but requires high technical skills and experience from the practitioner, whithout which this technology would certainly not be developed.

Outlook :  with increasing experience in the application of our technology encreases our expertise and efficiency, which leads to  sustained  improving of quality, safety and major cost-benefit ratio. As for the research, our technology opens new approaches, such as we have seen in the field of neuroscience and criminal law. Psychopaths seem to be therapeutically accesible only endoscopically ( axis 4 ) in the 5th dimension of axis 3 ( focusing ). Mentally they are focused on this axis to narcissistic ( axis 1 ) acting out their claim to rule and their hatred. Somatically they have been found to have decreased neurotransmitter in the amygdala ( chemical focus on axis 3 ) and socially they are focused to manipulation and destruction as the meaning of life ( philosphy focusing ). A 5-D integrated psycho-socio-educational and psycho-pharmacological approach involving a clear and solid structure from criminal law could be prepared and implemented for this serious mental disorder.

Extended application : As people live and work in structures and systems that were created by them, the structural elements of human psyche can be found within these social structures. The social structures have a life of its own, and this in turn implies that such structures themselves are either healthy or sick. In the treatment of patients the sick elements of social structures in which they live and work , again and again come to the fore and must be treated. As in recent years, depression, anxiety, burnout conditions, but also the use of violence in connection with family, business, schools, neighbourhood, etc. accumulate, our institute has put together interdisciplinary working groups, with the theme of health issues  concerning : 1. Companies, organizations and systems , 2. Health systems, 3. education, pedagogy and school, 4. the music scene. In these groups we develop the 5-D technology for the specific field and identify opportunities to implement the results of our research.