Medicine vs health care

I have a cold and my head is doing that underwater whomp-whomp pulsing thing and every sound feels like someone driving an icepick into my ears, like typing right now is excruciating and I really should just go downstairs and hide in the dark and the quiet with my book and my sticky tabs, but…

An interesting conversation started (on twitter, where else?) and then my one in particular picked up a different thread of it here at home and now it’s all swirling with this other post I’ve been meaning to write. So, here in my virus addled state, I’d like to dive in, because why not.

I want to talk about Western Medicine and how it is NOT health care, and how if we want health care we need to a. change the conversation and b. change the way we do pretty much everything that we consider “health care” now, but which is really medicine.

Disclaimer – This piece is going to read like I am doctor bashing – I want to make it clear that I think most doctors WANT to help their patients, they want to help them to have healthy lives. However, the medical system we have created in America doesn’t have room for doctors to practice health, only to practice medicine and the two are VERY different. So please, understand I am not attacking individual doctors, I am attacking a broken system that incentivizes and rewards the wrong things.

This does NOT mean "Intervene at all cost!"

This does NOT mean “Intervene at all cost!”

Okay, quick history lesson – WAY back in the day, in China, people used to pay their physicians every month – but ONLY if they were healthy. When you got sick, you stopped paying. This created a culture where doctors were invested in keeping people healthy, because that was how they made money. It also created a culture where once people were sick, doctors were incentivized to make them healthy again so they could go back to earning. Doctors did not profit from illness or hardship, they profited from wellness and health.

Here in America not only do doctors not profit from wellness, they also don’t profit from many of the things that promote wellness and long-term health. They are incentivized to look for, find, and treat illness – not to actually improve health.

The conversation that started this morning was about how this woman used to be morbidly obese, and how when she thinks about those days and remembers what she ate compared to now, it’s like night and day. Now she drinks a glass of water every morning before anything else goes inside her. Her house is filled with fresh fruits and veggies. She cooks her own meals from real ingredients most days.

She is no longer obese or even overweight. Her skin condition has cleared up, her hair is healthy – She is healthy.

Her doctors did not do this for her. They did not recommend this course of action. I mean, yeah, sort of, they told her to lose weight and exercise, but they didn’t say – drink water, eat fruit and vegetables, go outside. They did not prescribe a healthy lifestyle.

What the doctors did was perform weight loss surgery, which ultimately would have failed if this woman hadn’t been invested in making these lifestyle changes and committing to living a healthier life on her own. There was no “physical therapy” or “food therapy” or mental health consideration in her post-surgery plan. The doctors simply took her money (or her insurer’s), did the surgery and sat back. Their job was done. What she did next didn’t concern them because they were not paid to follow-up, to create a nutrition plan, to develop an exercise routine… They were not invested in creating health because that is not what pays their bills.

This woman was lucky that she was able to make those lifestyle changes – not everyone is able to afford to switch from a processed food diet to a real food diet. Real food is expensive in this country, and it takes time to cook meals at home. Time and money are both precious commodities these days as the middle class shrinks and slides ever closer to poverty and the minimum wage refuses to budge toward a living wage, forcing people to work multiple jobs for inadequate returns.

But “health” insurance doesn’t cover vegetables. It doesn’t cover fruit. Or gym memberships, or the purchase of a bicycle so you can ditch your car and exercise your way to work. “Health” insurance covers medicine, surgery, intervention. It covers the things that Chinese physicians used to have to do for free to return their patients to health, those last-ditch efforts – not the first line prevention. And this is because health insurance used to be “Oh-shit” insurance. Insurance is supposed to be for when things go wrong, which is supposed to be rare. But for that to work, we need health care that focuses on health, not medicine.

There are a lot of things health insurance doesn’t cover, but the most important thing it doesn’t cover is a conversation with your physician. As a result, more and more physicians are being told to reduce the time they spend with patients.

We see the results of this in everything from my friend whose young daughter was just diagnosed with diabetes and who had to go home and learn what that meant and how to care for her child beyond the daily insulin checks and shots – She had to learn on her own how to cook for her child, what snacks were okay and what snacks were dangerous… Because that is not the doctor’s job. His job was to deliver the diagnosis and write the prescription for insulin. Educating my friend on how to keep her daughter healthy is outside his purview.

We see it in the three trips I had to make to the doctor to diagnose a skin condition on one of my kids because the doctor didn’t actually look at her skin the first two times!

We see it in my other friend whose son was diagnosed as learning disabled when actually he just had an ear infection that made it hard for him to hear, and therefore hard to learn to speak – when all the doctor had to do was look in his freaking ears!

My one in particular picked up the failures of Western Medicine in a completely different place – the recent resurgence of heroin use in our country.

Apparently this resurgence has come about as a result of the over-prescribing of opiates combined with a distinct lack of a plan for how to ween patients off of them when they no longer need them, combined with the fact that many patients are being given what amounts to life-long prescriptions of these powerful “habit-forming” (read addictive as fuck) drugs, combined with the fact that street heroin is CHEAPER than prescription opiates!

So, what is the solution?

Well if the goal is to create improved health as opposed to simply treating pain, then I can think of a few – first, if someone has chronic pain that will last them the rest of their life and the goal is to manage the pain without reducing health, why not look into less addictive treatment options?

Lets start with massage which can greatly reduce all kinds of chronic pain. Acupressure & acupuncture have also been shown to be highly effective and less harmful treatments for chronic pain than prescription opiates, but these are not covered by most insurance plans and are not considered/prescribed by most doctors. (Thanks to Veronica below for reminding me to include these options! Stupid cold.)

If those low risk interventions fail to help the problem, Cannabis has been shown to be incredibly effective for many types of pain and is non-addictive in its natural form. (Don’t get me started on the shit-show that is synthetic cannabis.) But for doctors to be able to use that, we’d have to get the federal government to change its classification, we’d have to start allowing more research to be conducted into the medical benefits of this drug, and we’d have to go back and dig up all the previous research that got buried in the height of a racially charged fear campaign against this plant.

Second, for patients who are not using these drugs forever, doctors should be creating plans to help patients wean themselves off these potent and addictive drugs once they no longer need them. They should not be cutting them off cold-turkey. And this plan should be discussed in advance with the patient.

We talk about a patient’s right to know, but when it comes to these drugs, it’s up to us to read the warning label. NO – doctors need to sit down with their patients and tell them about the risks of these drugs and create a plan to mitigate those risks. It should not be up to the consumer. The doctor should not be off the hook as soon as his or her pen leaves the prescription pad. (And no, I’m not advocating for more malpractice lawsuits, I’m talking about returning to a time when doctors had a relationship with their patients.)

Last, prescription drug prices should be regulated and reduced. Before anyone screams “But capitalism!” at me – most of the funding for new drugs comes from government grants anyway, so once again we are socializing the cost and privatizing the rewards. Let’s stop that.

These are just two tiny examples of places where medicine trumps health in our culture. There are a bazillion more.

We could talk about the medicalization (not a word, I know, roll with me, I’m sick) of pregnancy and the resulting insanely high rates of cesarean sections in the USA compared to other countries and how in other countries healthy pregnant women who do not require intervention have midwives or nurse midwives as their primary attendants which reduces cost AND improves outcomes!

We could talk about how many kids are being given high potency ADD and ADHD drugs rather than a prescription for better nutrition and increased exercise. I’m not saying that some kids don’t benefit from those treatments, I just don’t think they should be the first option.

We could talk about the number of doctors prescribing antibiotics for viral infections, even though they know better – but their patients have gotten so accustomed to getting some sort of medicine that doctors no longer feel like they can say, “go home, drink herbal tea with honey, eat some chicken soup, watch bad TV, rest.” First, that takes too long and doctors aren’t paid to consult, and second prescribing health doesn’t pay, prescribing drugs does.

We could talk about diet pills and mood pills and the number of unnecessary and often invasive procedures done on patients who do not need them.

We could talk about the ways doctors are trained to look for ailments to treat rather than look for health to boost.

We could talk about the increase in allergies, both food allergies and other allergies and what that means and where that is coming from and how we are treating the symptoms rather than the causes…

We could talk for DAYS about end of life care that promotes quantity of breaths over quality of life.

Pick any area of “health” and you’ll soon see that it has become an area of medicine, often at the direct detriment of actual well-being.

Doctors get paid per action – per prescription, intervention, surgery, shot… They do not get paid to sit down and talk about what is happening in their patient’s life that might be causing poor health. They are not paid to talk about diet and nutrition and exercise and stress and work and all the other things that feed into who we are and how healthy, or unhealthy, we are. They are not paid to promote or create health – they are paid to treat illness, disease, pain and trauma.

And… Even if they were – out here in the real world, outside their offices, there is little to no support for people who try to make that shift on their own. It’s not like fruit and veggies cost less for people on food stamps. Whole grain bread isn’t cheaper than white bread. There’s no system in place to help someone who is already struggling just to eat make the leap to eating well. And I don’t know about the rest of you, but every time I take out my calendars and start color coding my days I find that I have way more things to do than time to them. Imagine if I was working two jobs while raising children without a partner – where in the world would I possibly find the time to exercise or cook from scratch? And how would I learn how to cook? There is no support for that. No one is stepping in or stepping up to help people balance their life better, because that costs money and we’re all broke.

So, we need to change the conversation. We need to acknowledge that when we’re talking about medicine, we aren’t talking about health. And health is where it starts – with reducing stress, with increasing nutrition, with making sure that EVERYONE has time to go outside and take a walk (and that they can do so relatively safely).

We need to make sure that doctors have follow-up plans with their patients after procedures and after prescribing drugs. I keep hearing that homeopathy and naturopathy don’t have the backing of science because in blind trials those treatments are no more effective than placebos – and yet in study after study in the real world, they actually do work. Why? Science says it’s because those practitioners SPEND TIME with their patients, they talk, they create wellness plans, they do the work to promote and create actual health rather than just treating ailments and allowing their patients to resume poor habits that create bad health again in an endless (but highly lucrative) cycle.

If we want better health outcomes, we need to smash this broken system all the way down to the ground and rebuild it from scratch, centering actual health and wellness (including helping all people access healthy food and active lifestyles) and pushing medicine back to the fringes of last resort where it belongs.

 

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13 Comments

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13 responses to “Medicine vs health care

  1. Can I add than massage can do WONDERS for some chronic pain conditions, migraines, med-mild plantar fasciitis, med-mild carpal tunnel syndrome, TMJD, stress(which causes SO MUCH HARM)……the list goes on.

  2. YES! Thank you! I meant to. Have edited, with attribution. Thanks.

  3. You have some really interesting points here, and I agree that the American (read: U.S.) medical/health care system invests in the wrong things. That being said, I’d argue the problem is even deeper: American culture values paying someone to fix things for us. I love your example about the woman who developed a healthy lifestyle, because she did what I think we might agree is a very UN-American thing – she took responsibility for her own well-being. What’s dangerous about focusing on medical practitioners alone (again, I agree with your point that this is important – I just think that it’s only taking on about half the problem) is that we leave what trained the doctors to view medicine this way. It’s not just the economics – what social and cultural choices in how our society is set up teaches and reinforces that this is appropriate? How do people who are generally speaking committed to helping people be well and functional live with themselves at the end of the day if all they are doing is fixing a problem, taking the money, and running?
    Consider: we have a two-pronged cultural view of the world. One part says, we buy things, experiences, etc. This includes “cures” (the quotes are intended to indicate my own skepticism about what a “cure” is, since we all understand them differently). Another part says, we’re all so unique and individual that no one else should tell us what to do. That part tells us, as members of society, that we are absolved from following guidelines for “what makes humans live healthily and well” if we don’t want to because we are “special.” Don’t forget American exceptionalism here is working at its finest.
    Sorry for the long response but I, too, have strong feelings on this one.
    What I admire about the woman in your example is that she took responsibility for trying out the guidance that says eat well, get exercise, avoid processed foods – and learned that it works. Yay for her. Let’s get the rest of American society to consider trying it and maybe we can allow doctors to have a role as teachers, guides, and occasionally, when the need arises, the ones who go in to do a radical fix because sometimes just healthy living isn’t enough.
    Thanks for talking about this!

  4. We heard your voice there, but no need to go to the other extreme though πŸ™‚

    • I hear you – as much as I can through the *whomp-whomp* underwater brain thing. That said, if health comes first, then medicine becomes a last resort almost by default. Medicine becomes what we do when health fails, rather than a thing we abuse in a misguided pursuit of health.

  5. Thank you – this is an issue that I feel is so close to my heart and many sensible points were brought up.
    Many times have I had had the conversation with my aging – and ailing – parents about what constitutes “health care” vs. a pill (or surgery) for every ill. I’ve talked until I’m blue in the face, but in the end it’s their choice to continue eating their processed crap and take their pills to reduce the side effects so the so-called “food” they’re eating.
    I used to eat like that – I didn’t know better. But then I did my research, got educated, changed my lifestyle. My boyfriend and I lost over 200 lbs combined – no surgery, no pills, no doctors. This was us not previously knowing how to cook or anything, just making simple homemade salads and soups. As we learned to cook through practice we got more elaborate. But the point was, we were putting our foot down and refusing to eat any of those thing that don’t contribute to our body’s health.
    Oh, and I’m not trying to be argumentative, but eating healthy fresh food doesn’t have to be more expensive – especially if one prepares everything at home and packs lunch to go. Our grocery bill was higher when we were addicted (yes, it’s an addiction) to fast food, processed microwaveable dinners, “sugary” cereal, chips, cookies, soda, etc. Sorry, just that it bugs me when people use the excuse “we can’t afford to eat healthier” while each member of the family eats out, has a new iphone, or other luxuries. It’s called priorities. I’m definitely not wealthy, lol, quite the opposite.
    How many times I’ve said that if doctors “prescribed” a certain way of eating, rather than just suggest vaguely to eat healthier, people would actually listen! Too many people see the diet part as negotiable, while the precribed drugs are a must.
    Of course, I do realize that there is an interest – to ask by whom is to open a can of worms – in keeping the masses unhealthy and uneducated. It’s very unfortunate.
    And yes, cannabis is an excellent pain medication. Before any one starts freaking out about “oh people just wanna get high!”, when extracted into oil and rubbed on the painful area it helps so much. Found this out after a car accident years back, as well as a recent ankle sprain.
    Agreed that the system needs to be rebuilt from the ground up.
    Sorry for writing a book for a comment. Love your blog.

    • LOVE that you wrote a long comment – it means I got you excited and thinking and that is what I aim to do!
      I agree that once you know how to shop and cook for yourself it becomes cheaper than the alternatives, but the transition can be really hard for people who are just starting out.
      I’d really like society to help make it easier to eat healthy and to make health choices over all. I think we need to start holding businesses accountable for the harm they cause rather than putting all the blame on the consumers who, as you noted, often don’t truly know better.
      We should also be educating people starting in grade school about healthy eating. Yes, I’m all for social engineering and indoctrinating youth with facts πŸ˜‰

      • Definitely in agreement here – the businesses should be held accountable. If I see another Mickey D’s commercial in which the people all look thin and healthy – while making an expression of unbridled delight – stuffing their faces I’m gonna scream! How about some commercials that show the real aftermath of eating there? Or cigarette pack style warning labels?
        I’m right there with you about the social enginnering and indoctrination with facts. After all, a yound mind is like a sponge, gotta get them while they’re young. Imagine if the corporations that produce this crap were required to spend a percentage of their profits on social programs to educate people on nutrition, PSA’s warning of the very real health dangers, educational programming for children (and heck, for their parents too), or if there were tax breaks for eating heathier just like there are for buying new cars. Well, I can dream on…

        • YES!! Let’s dream together!
          I’m over at my food blog right now dreaming out loud about changing this culture. If enough us dream big and loud, maybe we can change the world! After all MLK Jr. started with a dream! πŸ™‚

  6. Pingback: Health care vs FREEDOM! | ThinkBannedThoughts Blog

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