It was focused on treating short bouts of illness caused by a specific disease often localized to a particular organ or organ system. However, the CDC estimates that over half of adults in the U. While we will always need acute care, managing chronic illness requires a different mindset. Physicians must consider not only the physical disease, but psychological, cultural, and socioeconomic factors that contribute to the illness. It is no longer enough to simply treat the most pressing symptom and wait for the patient to return when the condition gets worse.
In the s, 60s and into the 70s, primary care physicians were well respected members of the community and helped patients navigate and coordinate more specialized care. However, as Forbes columnist Todd Hixon beautifully summarizes :.
In the s and s, as the cost of healthcare became burdensome for corporate and government payers, the dynamic changed. The federal government and the insurance companies created a structure of procedures and payment rates for each.
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Procedures based on higher levels of training and technology received higher fees. The Feds and insurers tried to push down prices of procedures, but at the same time they rewarded advances in medical knowledge and technology, and the result was highly trained specialists were well paid for performing sophisticated procedures, and family doctors were squeezed.
With money flowing to specialists, primary care doctors were forced to see more and more patients and had less time to spend with any one patient. Unpaid services such as preventive care and care coordination quickly went out the window. With the lure of greater prestige and earning potential, medical students funnelled into specialties, creating a deficit of primary care doctors. The procedure-based payment structure rewards doctors for doing more, even when it might be better to do nothing.
Our healthcare delivery system spends more than billion of its 2. And, most alarmingly all that ineffective treatment and harmful care represents one-third of tests, treatments and procedures that physicians perform. When evidence is incomplete or conflicting about when to use a particular procedure, surgery or diagnostic test…some physicians will treat more aggressively, especially if piecework reimbursement rewards that. Unfortunately, only about 20 percent of clinical procedures have solid scientific evidence to back them up.
When the patient is reduced to a vehicle for disease, the doctor becomes the most important person in the healthcare process. This may work fine when medical decisions are straightforward. As Dutch social scientist Jozien Bensing notes:. All too often, the patient buys into the mindset that decisions about their health are best left to doctors.
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They become passive recipients, rather than active participants in their own care. This may have been acceptable when the aim of medicine was simply to keep people alive, but chronic conditions, in particular, require the patient to play a larger role in managing their own health.
Adding fuel to the fire is a rising tide of chronic illness. A glut of cheap calories in the American diet and a lack of daily activity have led to a dramatic increase in obesity and its associated conditions such as diabetes and heart disease , particularly in the last 30 years.
Meanwhile, the Baby Boom generation, which represents a quarter of the U.
This is a period of life when we become more vulnerable to illness and chronic conditions tend to accumulate. A new paradigm is needed that treats the whole patient and establishes a more balanced relationship between doctors and their patients.
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Demand Better! Second River Healthcare Press, The Flexner Report — years later. Yale Journal of Biology and Medicine. Public Trust in Physicians — U. Medicine in International Perspective. The New England Journal of Medicine, A controlled trial to improve care for seriously ill hospitalized patients. Injuries, which can also be treated by modern medicine, occupy one of the other seven spots. Across the globe, non-communicable diseases are the 1st, 2nd, 3rd, 5th, 6th, and 7th leading causes of death.
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In high-income countries the data are even worse. Nine of the top 10 causes of death are a result of non-communicable diseases.
Of course not all non-communicable diseases can be directly linked to lifestyle choices. Genetic and environmental factors play roles beyond our control, for example. Ischaemic Heart Disease Coronary Artery Disease : Age; sex; family history; smoking ; high blood pressure ; high blood cholesterol levels ; diabetes, including Type 2 diabetes ; overweight or obesity ; physical inactivity ; high stress ; unhealthy diet. Stroke : Being overweight or obese ; physical inactivity ; heavy drinking ; drug use, particularly cocaine or methamphetamines ; high blood pressure ; high cholesterol ; smoking ; diabetes including Type 2 diabetes ; obstructive sleep apnea; family history; cardiovascular disease ; age; race; sex.
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Western medical science has been deemed miraculous for the lives it has saved and the suffering it has prevented. It is even more miraculous that medical scientists can create medications to help us alleviate lifestyle choice-based illnesses, for example by helping reduce blood pressure or cholesterol. But this latter miracle should give us considerable pause. Far from it; who knows what other miracles we may discover and how much more pain and suffering we may prevent. But regardless of what medical scientists invent, their task is more suited to finding cures for what attacks us from the outside, not what we put into ourselves.
Medical science remains first and foremost a means of dealing with with nature throws at us, not at what we do to ourselves. Become a member. Sign in.
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