10 Things That Need To Change About Health Care In The U.S.
My friend Carrie is a 40-year-old woman who had her yearly physical a few months ago and was informed that she has high cholesterol and is overweight.
Her 15-minute visit went like this: the doctor walked in, looked at her lab work, and vital signs. Then he shined a light in her eyes, nose and mouth, and did a quick stethoscope check of her heart and lungs.
Finally he sat down and wrote out a prescription for a drug to lower her cholesterol. He also advised her to "lose some weight." He asked her to return in six months, smiled, and hurried along.
Carrie was frozen with confusion and concern. She had questions but couldn't remember any of them.
On her way home she called me (her doctor friend) to discuss. I cringed as she described her visit, feeling sympathy for her and embarrassment over modern medicine.
"I'm sorry," I said. "I'm sure he meant well, but he just didn't have the time or training to explain."
Since that day I've thought about the ways we would improve Carrie's experience and outcome — and improve medicine for all of us.
I realize that the big problem with healthcare today is the rising costs and I only touch on that because frankly I am not smart enough to tease out all the complicated players in health care costs. But, with healthcare costs (as with anything), we should fix the root problems first instead of slapping on a band aid.
So what 10 things could we do to improve our healthcare system? Inspired by my friend's visit, here are some starting point:
1. Teach doctors and patients the basics of healthy eating.
I know, there are so many diets out there, how would doctors even know where to begin? Or which one to recommend?
Well, there are a few things that paleo, vegan, and Mediterranean all agree on. Let's focus on the basic intersection points: eat whole foods, eat less sugar, and eat more vegetables. If someone would have told Carrie that, she would have had a starting point.
In my medical school (as with most in the country) we received about seven hours total of nutrition lectures, most of which was technical and abstract. That may sound like a lot, but we had about five hours of lectures every day — so nutrition was just a tiny portion of our education. As a result, many doctors don't feel they can provide dietary recommendations to their patients, or they don't believe in the power of food to heal.
If we educated doctors on the basics such as effects of sugar and processed foods, and gave them some practical knowledge, I'm convinced it would change how we all practice medicine.
2. Change the unwritten mantra: one disease equals one cure.
Modern medicine was so transformed by the discovery of antibiotics that now we look for a pill to "cure" everything. In Carrie's case, there is no one cure; no pill can make her lose weight or cure her elevated cholesterol. If we didn't focus on the one cure so much, maybe we'd direct people to learn more about how to sleep more, eat better, or lower their stress.
3. Use medications as an add-on option.
Are medications important? Yes. As much as I'd like to believe that we can cure everything with diet, exercise and lifestyle, we can't. For example, some people have tried all the natural diabetes cures in the world, but they still need medications.
Why don't we suggest that patients try to find the root causes of their ailment, listen to their body, and try to cure themselves naturally? If that doesn't work, we can add medications for help.
4. Teach medical providers about hormones.
I'm not talking about testosterone or estrogen replacement but the normal role of hormones in the human body. No one talked to Carrie about how her adrenal hormones may be contributing to her weight gain or her risk of heart problems. And no one told her that her exaggerated pre-menstrual symptoms are hormonal. She had no idea that she could fix this and lose some pounds just by balancing her hormones.
5. Bring back the idea of spending time with patients.
It's the age-old excuse all people in medicine (myself included) use: I don't have the time. I know it's hard, but to have any meaningful conversation about a persons health, you have spend some time.
One suggestion would be to have someone trained in nutrition and fitness provide a personalized follow up (in person, by phone, or email) with each patient. This would negate the need for more office time but give people a framework about sleep, exercise and nutrition.
6. Weave in ideas from functional and ancestral medicine.
Luckily for Carrie (and all of us) there are many smart people out there working very hard to change how we fix our body through functional medicine (which looks at root causes) and ancestral medicine (which looks at way our ancestors ate, moved and slept as clues to where we have since gone wrong).
What we need to do is synthesize the nuggets of knowledge and incorporate them into how we practice medicine. For example, gluten and dairy seem to negatively influence many inflammatory and autoimmune disorders. This is a concept embraced by functional and ancestral medicine, but something conventional medicine has not yet accepted.
7. Reconsider our obsession with evidence-based medicine.
Policy makers and researchers in the medical community are fixated on "evidence-based medicine," the idea that there has to be a double-blind, placebo-controlled randomized trial to support any recommendation. Sounds good, but in practice, it's promoting the "one drug, one disease" dogma since drug companies can show their drug can help one outcome. Real life doesn't always work like that. Plus, who has the money to do large, randomized, placebo trials? You guessed it: drug companies.
8. Separate medical care into "fix it" medicine and "tune up" medicine, and invest in both models.
Carrie got a "fix it" philosophy. That's great if you break your leg. (In fact, modern medicine can be amazing when it comes to life threatening crises!) But Carrie doesn't need a quick fix! She needs guidance about how to improve her health so that her body doesn't break down.
While I won't go into detail here about the costs of healthcare, I will say that the majority of our costs go toward treating life-threatening crises. It's like we devote all of our money to fixing the train crash, but little into the train upkeep. By ensuring the train runs well, we may save ourselves cost and grief in the long run. So, consider two separate treatment models.
9. Give patients permission, knowledge, and information to heal themselves.
Have you ever taken a class in school where this is no homework or reading involved? We should not expect that all of our knowledge will come from those oh-so-brief meetings with our physician.
As doctors, we need to direct people to self-healing resources. We should not shun the internet as an information source — instead, let's point patients to reliable, trustworthy websites and encourage them to supplement their knowledge with books.
Carrie said she was overwhelmed with the diet advice for cholesterol and weight loss on the internet and wishes someone could have just pointed her to a few unbiased, reliable sites.
10. Warm up to alternative medicine.
At her six-month follow up, Carrie's doctor asked what she had done to decrease her weight and cholesterol. She said that she'd decreased her reliance on fast foods and soda and started doing some deep breathing exercises to manage her stress. She also added some medicinal herbs.
He said "good job" but looked at her skeptically and went along to the next patient.
It's like she figured out this amazing, novel way to solve a puzzle … except he wasn't interested.
As I said, sometimes I'm embarrassed by modern medicine!
I am not naïve enough to believe that we can all improve the system quickly or easily. But, ultimately we need to change healthcare for all of us, so why not start with some of these ideas?
If you like these ideas, join me here and sign up to receive a free whole foods, dairy-free, and gluten-free meal plan to try. But if what I've said doesn't resonate with you, no worries. (I'm not offended!) Let's just keep brainstorming and come up with more ideas to help healthcare.