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.
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.