Recently, representatives of Shouldice Hospital were invited to attend a conference at Harvard University to discuss the merits of "consumer driven health care" as a new model of health care delivery in the U.S.A.. The current American system of managed care is under the public microscope because it has resulted in limited patient choice and it has left over 40 million working Americans without medical insurance.

Managed care first became popular in the late 80's when insurance costs rose dramatically. However, the focus then was put heavily on cost reduction instead of patient care. As one American delegate at the conference compared: "Second Cup coffee shops have taken a commodity item and turned it into a personal experience. We've taken a personal experience (health care) and turned it into a commodity!"

Their interest in Shouldice stems from our success through such a focused approach to health care. We have proven that high quality health care can be delivered at a low cost. The Shouldice model has also been partially replicated in various fields of medicine such as cancer treatment and coronary care centres in the United States with great success. Shouldice was called upon to submit a paper highlighting some of the benefits of the focused model as we practice it here. Papers written for the conference will be published in June, 2000 in a book entitled "Consumer Driven Health Care".

Recently a survey was completed at Shouldice Hospital to determine patient perspectives towards in-patient treatment for hernia surgery. In many North American hospitals hernia patients are treated as out-patients and are discharged after only a few hours of professional care to recover at home. In the United States many insurance plans also don't seem, at first glance, to provide in-patient coverage for hernia surgery. But what do the patients want? and What is the cause for this move towards immediate discharge? The survey revealed that 93% of patients wanted in-patient care, 5% didn't answer the question and 2% thought out-patient care would be fine. Out-patient trends, not covered in the survey, have been documented elsewhere as being driven by financial constraint in both Canada and the USA. Which will prevail, patients or dollars?

An holistic approach to hernia repair has long been the preferred philosophy practiced at Shouldice Hospital. But what do we mean by holistic within our domain'? Contrary to comedic perception. the notion that our "holistic" approach is tied to repairing "holes" in the abdominal wall (hernias), has little to do with it. In reality, the holistic concept which we practice is true to the meaning of the term as it has come to be known in modern times. We treat the "whole" not "hole" person, mind, body and spirit.

The Oxford dictionary defines "holism" as : tendency in nature to form wholes that are more than the sum of the parts by ordered grouping; .so ~ istic. In health care, the holistic philosophy includes many steps of care pertaining to various aspects of the human system, all of which are timed and ordered to form a complete process. This integrated systematic approach provides a more effective result than a disconnected application of the same steps. The combination of steps addresses the needs of the physical being, the mental being and the relationship between the two. "Mens sana in corpore sano" is one latin version meaning a sound mind in a sound body. The idea is that each is better served when both are in good health.

At Shouldice Hospital the importance of this relationship has been recognized for many years and, as Shouldice patients know, it is an essential aspect of the Shouldice approach to delivering health care.

Many steps are taken to help patients relax and feel confident as well as understand what is best for them before and after surgery. Education is part of the process. This happens in both formal and casual settings. It is often said that specialized care in a hospital where all patients are being treated for the same condition helps everyone to recover faster. Patients have a good understanding for each others' experience, as do the staff. Concerns are not left unanswered and no one is left unassisted to deal with their condition alone or uncertain. Thus the mind is served.

Physical aspects of care at Shouldice, aside from the surgery itself. include nutrition, exercise. rest and medication. Meals are served in accordance with the Canada Food Guide for balanced nutrition. Postoperative exercise. both organized and informal is tailored to the needs of hernia patients. Rest and medication is handled on an individual basis as needed. When patients are discharged from the hospital they are physically prepared to resume their normal lifestyles as quickly as possible. The time and resources needed for physical healing have been integrated into a professionally supportive environment. Thus the body is also served, which fulfills our holistic objective.

If you have any comments you would like to share with your fellow patients please submit them to: NEWSLETTER, c/o Shouldice Hospital, 7750 Bayview Ave., Thornhill, Ont., L3T 4A3 or e-mail us at [postoffice@shouldice.com]