Sunday, September 23, 2012

Medical Care, Sick Care, Health Care....Who Cares?!


At the risk of sounding cynical or just plain difficult, I have to say that I am tired and bored by articles and books that tell us that we have a medical care system or a sick care system and not a health care system.  Dr. Steven Schimpff is one of the great thinkers in medicine and I apologize beforehand that his post on Medical Megatrends and the Future of Medicine is the initiating factor in this rant.  Dr. Schimpff outlines all the reasons that we have to focus more on prevention and also more on coordination of care and I agree with all of his points.  His argument cogently shares the statistics on causes of death which show that the preponderance of disease is due to lifestyle choices.  He nicely puts together what is said in many articles, blog postings, television medical shows, newspapers and everywhere else that we are killing ourselves by smoking, alcohol, drugs, poor eating habits, driving dangerously  and lack of exercise.    This all leads to the idea that we must foster a healthier lifestyle.  I get it and I suspect that by now if you don’t get it, you must be living in a cave somewhere (although if you are I suspect you are eating healthier and getting more exercise). 

However, taking medicine and our health care system to task for not fostering an emphasis on prevention is misguided.  Dr. Schimpff alludes to this in one of his historical points about the war against infectious diseases.  The tide in that war was turned before the advent of antibiotics by proper sanitation, hygiene and water systems, not by a health care system.  Many years ago I taught a course in preventive medicine to second year medical students.  I would always start the class by asking them who the most important professional was for preventive health.  They all said the primary care physician.  I told them my answer was the professional garbage collector as the collection of garbage prevented more illness than any primary care physician.  We have a societal and cultural problem that will only be addressed with societal and cultural answers not with medicines and with our health care system.  In other words:

                Our medical or health system (I don’t really care what you call it) should not be charged with changing our culture.

Those who change our society and our culture to foster a healthier lifestyle will likely be in disciplines other than medicine.  That battle will be led by those who put bike paths throughout our cities and countryside.  They will be employers who provide eating areas for their employees with healthy good tasting food.  They will be people like my son who worked on an organic farm and then wrote about his experience and another son who is dramatically changing the way people get their food by starting a company, Good Eggs, to foster a more direct farm to table eating experience (I can’t help it…I am proud of my children). 

                If you successfully create a healthy culture, people will still get sick and even die

Life really is a fatal illness and not all disease is “your own fault” as may be implied by the current emphasis on changing our health care system to focus more on prevention.  Dr. Schempff wisely calls for better coordination of care for those with chronic illness and this must be supported with new approaches being developed such as the approach at Accolade.  However all patients, not only those with chronic illness need that level of coordination in this era of fragmented confusing care.  I am not upset by our emphasis on healing the sick and on finding diagnoses and cures.  If I am sick then I want my doctor and other health professionals to focus on getting me well, not on blaming me for the lifestyle choices that led me to illness. 

So I am dedicated to changing our culture and society to be healthier and in the meantime, I am even more dedicated to finding ways to better treat people and families who are sick and in need.  At all times, the charge of all health professionals should be to see each person we treat as a loved family member and help them with energy, intellect and empathy no matter what choices led them to us.