When thinking about our current state of health care, I am reminded of a joke that one of my medical school classmates used to tell: “There was a little girl; who had a little curl right in the middle of her forehead; and when she was good, she was very, very good; and when she was bad she was…..popular!” In some ways, the current health care system is just like that little girl–popular. Yet, American medicine, so good in so many arenas, fails to measure up to the test most of the time when it comes to taking care of patients with chronic diseases.
A chronic disease persists for over three months and, in general, cannot be prevented by vaccines or cured by medication. For the most part, they don’t just disappear. Chronic illnesses now account for 70% of deaths and for the expenditure of over 75% of direct health care costs in the United States, according to the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services.  As of 1998, 88% of Americans over the age of 65 have at lease one chronic health condition. Leading chronic diseases and health problems consist of:
- Cardiovascular disease
- High blood pressure
The burden of caring for chronic diseases taxes our system over $1.5 trillion in direct costs and add several more billion dollars in the form of indirect costs such as lost productivity. 
Researchers Halstead and Lorig have this to say about chronic disease and our current health system:
“The present health care system is neither effective nor efficient. The dominant reason for this is a contradiction between the principle problem confronting the system—chronic disease—and the system’s methods of operating, which were designed for acute disease. Resolution of the contradiction requires a different practice of health care, with new roles for the patients, for physicians and other health professionals, and for health services.” 
Still we Americans clamor for more treatments, obsess about the lack of health care coverage for millions of Americans, and fixate on our collective chronic pain–all the time looking to the system and not ourselves for improvement. The Stanford Chronic Disease Patient Self-Management Program sets the stage for needed change in addressing chronic disease problems. Their program consists of a six weeks in community settings and covers the following topics:
- Techniques to deal with problems associated with chronic disease problems
- Appropriate exercise for maintaining and improving strength, flexibility, and endurance
- Appropriate use of medications
- Effective communication with family, friends, and health professionals
- How to evaluate new treatments
If you are blessed with being able to access such a program, by all means try it out. Meanwhile, why not start your own WellWriting practice aimed at exploring and reflecting on the topics taught in the workshop? Chronic diseases and pain syndromes often bring along their friends of frustration, fatigue, pain, and isolation. Write a biography of each and then write out your own prescription of dealing with each one.
Are you getting enough exercise or are you taking medication? Use your writing to keep an exercise or medication log, plan daily activities, and explore how you feel from the exercise and medication. Do the same with your nutrition and added new treatments.
One rich benefit of writing will be to explore how to describe how your condition and state so that you can communicate that in a meaningful way to friends, family, and the helpers in your life. If you want to learn more about the health benefits of putting a personal WellWriting practice into your life, consider joining us for a WellWriting workshop here in beautiful Half Moon Bay.
 James H. Thrall, MD
Prevalence and Costs of Chronic
Health Care System Structured
Treatment of Acute Illness. Radiology. 2005 Apr;235(1):9-12.
 Halsted Holman, MD
Kate Lorig, RN, DrPH: Patient Self-Management:
A Key to Effectiveness and Efficiency
in Care of Chronic Disease. Public Health Reports / May–June 2004 / Volume 119 239–243.
To read more about chronic health diseases, click here.