Editor’s note: In this piece, Natasha Deonarain MD, MBA, argues that the expertise of the conventional doctor at disease management is not totally in congruence with the World Health Organization’s definition of health. She has used the American health care system to drive home her arguments. Parallels can however be drawn with what exists in other parts of the world, particularly in developing countries.
It’s no secret that America is suffering from a huge crisis in healthcare. As we watch the sun rise on Obamacare, doctors, patients, insurance executives, hospitals, small businesses and legislators alike stand agape. No one seems to have found a simple, logical solution.
The solution is in fact very simple. It’s so ridiculously simple, it might make one laugh. And, believe it or not, it’s also amazingly cheap.
But because of its simplicity, it will also be the most difficult thing for America to implement. The disease-focused paradigm that’s been spoon-fed since the 1940’s and helped build a $2.8 trillion dollar “health care” industry will stand in its way, because it requires a profound change in our belief systems.
Let’s examine this idea from its beginnings and follow it to its logical conclusion.
Our beginning lies in our ability to first clearly define and understand the terms “health care” and “disease management.”
The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” That sounds easy enough to understand. But let’s move on to today’s entry point to health care.
Most people would go to a doctor for a health check-up. When they go to a doctor’s office, what is the first thing the patient will likely experience? Most physicians are trained to begin by taking a set of vital signs (blood pressure, temperatures, weight, etc.). The physician would then talk to their patients about any symptoms they’re experiencing. If the patient has symptoms, the doctor matches those symptoms to a disease classification system. He will then order tests to prove the presence or absence of disease.
If there is no disease on symptomatology, blood or image testing, what does the doctor conclude? Likely, the doctor would conclude that his patient is healthy by virtue of the fact that there was no disease detectable.
But go back to the definition of health by the WHO. Do these actions of a doctor actually fit with this definition of health?
It seems that searching for the absence of disease does not serve well as a definition of health. And yet this is exactly what physicians have been well-trained to do. In fact, doctors hold the default entry point to the determination of our health status — the proverbial health check-up.
Let’s return to a doctor and his or her training. Once a patient has been found to have a disease, how would that doctor typically treat his or her patient if the symptoms were significant to the patient? Most people would say that the doctor will recommend some sort of prescription to alleviate his patient’s symptoms; either an over-the-counter or dispensed drug. In the action of recommending a prescription (and perhaps some lifestyle changes to go with), what is that doctor doing?
By definition, the doctor has found a disease to diagnose, and is now managing the disease. In other words, the doctor is an expert at “disease management.”
If we look at medical training, it begins in a cadaver lab with the study of anatomy in dead people. From the reference point of death, a doctor then graduates over the years to studying diseased “specimens” in the hospital.
Once in practice, the doctor then continues to examine more and more disease. If the person comes in without disease, the doctor is trained to find a diagnosis that he can begin with, by virtue of his training. It’s relatively foreign to most physicians to begin inside a paradigm of optimal health, despite a patient’s disease labels, and continue “health care” without recommending any prescriptions, tests, procedures or specialty referral (disease-management).
So, after this analysis, we return to our basic question. If a conventional doctor is an expert at disease management and the definition of health is not merely the absence of disease, but this doctor works to determine the absence of disease … why are we convinced that we need to see a doctor as the entry point to make sure that we are all healthy?
Wouldn’t it make much more sense to see a different health practitioner, one who works inside a paradigm of health despite clinical diagnoses, before we see the expert at disease management? What then becomes our definition of health, right here in the US, with its fast failing health care system?
Changing this singular belief system has the potential to shave billions of dollars off a disease-focused health care industry, obliterate the “shortage of physicians” crisis, and correct epidemics of modern day, chronic disease. It can be done in the course of a blog. But, it will also be the singular most difficult thing to actually accomplish in America.
A ridiculously simple solution is right at our fingertips. There’s no need to panic, as we all are doing right now. All we require is a basic differentiation between the terms “health care” and “disease management” and then we can put each “player” into their respective roles which best fit their expertise. Mastering this concept is the first step.
So here’s a quick self-check to see where you stand on this matter.
A 52-year-old male comes in to his doctor with mild joint pains in his knees, hips, low back and shoulders. He does not take any medication nor does he have any other symptoms or diseases. Assuming all his tests are normal, what is the first prescription his “health-focused” doctor should write (based on evidence)?
Your answer will help you determine the paradigm that you operate within, and also whether you are indeed a health care provider, or a disease management expert.
Article is reproduced with the permission of the author.