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Doctor-Centered Healthcare

Healthcare’s Archaic Delivery Model 

Healthcare in America id doctor-centeredMuch of the failure of our healthcare system lies in the office-based “medical model” itself – doctor-centered, transaction-driven, intervention-oriented, and largely unaccountable.[1]

The shortcomings of this archaic model have become more evident with its failure to stem the growth in chronic diseases like diabetes and obesity.

Even reductions in heart disease – which medicine likes to claim credit for containing – are largely attributable in the U.S. to reductions in smoking and other lifestyle behaviors.[2]

The medical community would have you believe it’s due more to the arsenal of high-priced technology the cardiology community foists on an unsuspecting public.

This, in fact, may be the best evidence available that inexpensive lifestyle interventions like smoking cessation hold far greater promise for disease avoidance and rationalizing our medical mayhem than further reliance on a dysfunctional medical model of more drugs and procedures.

One of the overlooked features of contemporary medicine’s approach to chronic diseases is physicians paying lip service to improving diet and physical activity while relying increasingly on poly-pharmacy (more drugs at higher doses) as their preferred treatment regimen.

The strategy is to overpower the adverse effects of dietary abuse and sedentary living with ever stronger doses of medications, usually in multi-drug combinations.

This foolhardy attempt to strong-arm the body into better health by overpowering the negative effects of poor nutrition, inactivity, and other lifestyle deficiencies is a very high-risk/low-reward treatment strategy that generally results in a never-ending cascade of drug intensification.

The lack of efficacy of this strategy is evidenced by the abysmal outcomes seen by the majority of patients unable to achieve targeted treatment goals.

“When All You have Is a Hammer…”

This failed treatment approach is a perfect example of medicine’s stubborn refusal to recognize the obvious – the nutritional and lifestyle causes of most chronic diseases – because:

1) Doctors receive virtually no training in these matters and are ill-prepared, therefore, to recognize or address them; and

2) Their primary tool – prescription drugs – is what differentiates them from “lesser” providers and earns them their handsome livelihoods.

As they say, “When all you have is a hammer, everything looks like a nail”.

The failure here, though, goes even deeper.

Most drugs approved by the FDA are approved not in isolation, but as adjuncts to improved diet and exercise. Read the fine-print label on most medications and the odds are it will say something to the effect that “XYZ drug, in combination with diet and exercise, has been shown to…” do whatever the drug manufacturer claims its drug does.

This is especially true for drugs used to treat chronic diseases.

Why is this important? For starters, it suggests that failure to prescribe such medications in addition to diet and exercise is inconsistent with the terms of the FDA approval of these drugs. If so, these drugs are being prescribed in ways that deviate from the express terms of their approvals.

This may or may not constitute medical malpractice, but it certainly violates at least the spirit of the FDA’s findings and intent. The frequent failure of physicians to even mention lifestyle modification to patients while prescribing these medications reflects negligence in prescribing practices that is more common than not.

An even more proactive approach to treatment designed to lower toxicity risk and enhance effectiveness would utilize select herbal and nutritional supplements with solid evidence of effectiveness as adjunctive (assistive) therapies in combination with certain medications.

Integrative physicians know this and use them accordingly, but they remain more the exception than the rule.

Physician Convenience Rules

The point here is that the optimal approach would be to use prescription medications cautiously and only in conjunction with diet and exercise regimens appropriate for each patient’s condition, rather than as stand-alone treatments as generally prescribed today.

In many instances, this is the precise language of the FDA approvals granted certain drugs, yet medical practice routinely ignores this condition of FDA approval because the office-based medical model doesn’t lend itself to lifestyle counseling and support.

In other words, the FDA approves most of these medication “hammers” only if they’re used with less dangerous tools (diet and exercise). But the medical model isn’t well-equipped with these other tools, so they just hammer away.

It gets even worse. Repeated studies show that lifestyle measures, specifically diet and exercise, outperform medications for many diseases, including type 2 diabetes already reaching epidemic levels.

We have good evidence – in “gold-standard” randomly-controlled trials that the medical community requires – that treating type 2 diabetes with lifestyle measures is roughly twice as effective (59% vs. 31% success) as the most popular diabetes medication.[3]

Yet not only do most physicians generally ignore lifestyle measures – they take more time to manage than writing a prescription – but many don’t even mention proven lifestyle measures in addition to high-risk medications.[4]

This common practice – more rule than exception – demonstrates doctors’ selective approach to evidence in making routine treatment decisions. What’s used is what’s convenient for doctors, not what the evidence shows is best, and safest, for patients – an apt definition of “doctor-centered patient care”.

This needs to change if we’re ever to rationalize a healthcare system that’s grown like topsy – with little rhyme or reason for much of what passes as medical practice today.

[1] “Medical model” is also used to mean taking a family history, measuring vital signs, performing a physical exam, ordering relevant lab and/or imaging tests, and evaluating results to reach a diagnosis.

[2] Cardiovascular risk factor trends and potential for reducing coronary heart disease mortality in the United States of America. Bulletin of the World Health Organization. 2010;88:120-130.

[3] Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med. 346:393-403. 2/7/2002.

[4] The State of Health Care Quality 2009. National Committee for Quality Assurance. 


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