Tuesday, August 9, 2011

Let's Rediscover Preventive Health Care

For a long time the practice of medicine in the United States has been on the wrong track and patients have been losing confidence in doctors.  There are a number of reasons for this change.

  • Modern, western-style medicine treats symptoms rather than seeking to identify underlying causes.
  • Contemporary medicine emphasizes the use of expensive, high tech equipment and procedures, some of which are incomprehensible to patients.  It does this even in situations where less expensive, more straightforward approaches might work just as well.
  • Increased specialization has led to a situation in which nobody (except the patient, if s/he is capable of doing so) takes a holistic view of the patient’s situation, yet the human mind/body is a complex system whose parts interact in complex ways.
  • As a result of the first three conditions, many individuals adopt a passive role in relation to their own medical care.  They take no responsibility for maintaining their own health through diet, exercise, and other means available to them.  When problems do arise they expect the doctor to provide a solution in the form of treatment.  If the treatment does not resolve the problem they often blame the doctor.
  • In order to economize on time, doctors categorize patients rather than treating them as individuals.  While this approach may save time, it can lead to misdiagnosis and to treatments that are useless or even harmful.
  • With the exception of diagnostic tests, contemporary medicine in this country has largely abandoned preventive medicine.

For the most part, the deficiencies in current medical practice are not the fault of doctors.  The vast majority of physicians are sincere, caring people who are doing their best to treat too many patients in too little time.  Preventive maintenance is better than crisis intervention but most doctors are so busy doing crisis intervention that they do not have time for preventive maintenance for either their patients or themselves.  Doctors work impossible hours; they are harassed and talked down to by insurance providers; and they must protect themselves (at great cost) against lawsuits for malpractice.  We need a new approach to health care, one that costs less, does not increase demands on already-overstressed doctors’ schedules, and is customized to suit individual needs.  How can we accomplish this? The first step is to help and encourage patients to take more responsibility for their own health. 

First, there needs to be a new type of health care professional, a health coach, with training in fitness, nutrition, and general health, who would meet with an individual and help him or her create a health and fitness plan with appropriate goals. The coach would follow up with that individual as the plan was implemented and provide information and suggestions on exercise and diet. (Medical issues would be referred to a doctor or nurse.)   Health coaches could work in doctors’ offices, in schools and community centers, as well as in the workplace. 

Second, we need to discard outmoded notions about health and human life.  Traditional medical practice treats the human body, once it has reached adulthood, as solid and immutable.  In fact, the mind/body continues to change and develop throughout life.  It is malleable and capable of improving itself at any age.  The recent example of Dara Torres shows that motivation and hard work trump chronological age, when it comes to fitness.  The traditional view of old age as an inevitable process of deterioration needs to be set aside.  Many of the problems that are often attributed to aging are actually the result of inadequate exercise and improper nutrition.  If these issues could be addressed through education and follow-up with a coach, our health care system could save millions of dollars annually.

Third, we need to set up a system of health share networks, in local communities and nationwide, where people could communicate ideas about health and arrange to exercise together in groups.  These could be especially valuable in small communities where there are not enough doctors.  Taken together, these three approaches could vastly improve the quality or health care for individuals and diminish its cost.

An earlier version of this post was published in the Bloomington Herald Times.

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