Healthcare is not expensive it’s a scam of sorts or a misnomer- you decide
Understanding healthcare and how to make it work for you.
For every decision we make in life there is a cost.
Every headline about the healthcare industry is about how outrageous our healthcare costs are.
I work in the field and I do not believe healthcare is expensive at all. Let me help you see the reality from my side.
So I am a physician, I should say a “recovering” physician who has stopped helping people throw money into their disease process.
What does that mean? Let’s begin by understanding some basics.
So what does health look like?
First if you are healthy you would not read any blogs about health. That is what health is — we get its value when we lose it.
So do we really have healthcare?
Think about it. If you have a disease process and are taking treatment for it for a lifetime, that is not health care. It is disease management. So disease management is like putting sealer on a crack in the basement wall without figuring out why you have the crack.
It’s like mopping the floor of your basement without fixing the cause of the leak.
Health care should be about getting you back to health from a disease or problem or even better maintaining good health.
Today it is neither.
Because health as we know it should be well defined. There is a specific goal and it is a well known goal. For example, if you are a diabetic especially a type II, lifestyle induced, true health care should be about getting you back to being a non-diabetic and back to feeling normal and eating for nourishment and not maintaining the disease.
In disease what is the end? It is usually death or more disease or more medications, or more tests.
Here is an analogy you may understand. Imagine giving money to that basement drying service without fixing the leak — that is a lifetime of expense and in the process you lose your home too.
That is why our so called “healthcare” is a misnomer. It is really about disease management.
So why is it a scam?
Because doctors trained in the system including me feel we know what we are doing. We learn disease. But we confuse it with knowing health.
We know medications but we confuse it with knowing food.
We know testing but we have such significant cognitive dissonance that we ignore the patient and rely only on test results. If tests are normal and you have a symptom, it is really not a problem, so come back when the tests show the problem.
We forget that we are trained to focus on a disease, understand its progression and know the data on what works to keep it under control. We are not trained on how to understand the cause of the disease in this particular person and the steps we need to take to rebuild health.
Take cancer — we do not know how to reliably fight it. We fight the patient’s well being, when we fight their disease. They lose energy, they lose their looks they lose parts of their body. In many instances they “survive “ the treatment of the cancer. Instead of saying “I am a cancer survivor, I guess they should say “I am a survivor of cancer treatment.” Because in many instances the cancer does come back.
Imagine fighting an enemy , whom you do not know well-you really have no idea where it came from, what it is capable of, or what it is angry at, chances are you will not win that battle
This is what we do in our health care. We fight losing battles and consider ourselves the experts in the field of human health. We are barely experts in the field we are trained in and that is disease.
There is another player in this system too that keeps it going in the wrong direction.
And that player it you, the patient and I the patient. Over the years we have taught our patients to not rely on their intuition. For example, you gain weight you have not changed anything in your life — you have the same habits, eating not so healthy , never exercising and not sleeping and suddenly you wake up feeling sick, tired and depressed and you show up at a medical facility because you feel they should have a fix !
In your mind in fifteen minutes they will fix what you have accumulated over 35 to 50 years ! And that has to be a miracle- not medicine.
So how do we fix this broken and misnamed process?
So let’s look at the definition of health, which was defined by the WHO-
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Believe it or not we are fighting to redefine health. We are fighting to make chronic disease acceptable and normal, because it is on the rise.
Something that is common does not become normal.
Changes a patient needs to make
Love yourself enough to live a healthy lifestyle
Patients have two important choices to make when it comes to have physical or mental discomfort. “I need and I want”.
People who succeed have these two criteria- I need to change and I want to change, to get my health back.
I need to change but I don’t want to change, is a person in the pre-contemplative phase. That means they know there has to be something they need to change but are not ready to do so or they do not have time to change is this is the most exhausting patient for a physician. Most patients are here , because, they do not like to feel there is anything they can do.
They have tried and failed and do not want to try again or they are too afraid to make the change.
“I want to change, but I do not see the need to change” this is another kind of patient. An example is the thin patient who believes they can eat anything and the only measure of health they see is weight- so they do not believe the unhealthy foods they eat impacts them. This patient is exhausting too. Because how do you convince them that their lifestyle has other implications when weight is their only measure of health?.
The only way we can shift this, is to realize the truth in something that Zig Ziglar said about his weight issues — “When I chose to be obese, because you see, I never ate anything accidentally”- awareness that your health is your strength and you can impact it, this is what we all should do.
To be powerless and say it is my hormones, it is my genetics , it is my stress but hoping that the medical system has a medication that can fix it, that is expensive.
Let me give you an example. A classic conversation with a patient is when a patient comes in saying this:
“I have arthritis, my mother and grandmother also had it. They had to have knee replacements. Can I get a shot?” Already there in the patient has decided what they have, why they have it and what needs to be done.
The medical system has done its job in the indoctrination of both the doctors and patients that disease is common and therefore it is normal. Now you the patient becomes a cash cow because every 90 days you come in for that shot , and then eventually have a knee replacement because you see no other way.
Here is a novel question to ask- What if arthritis is only a symptom of the problem and not the problem?
Ask these questions? Could it be the extra weight ? Could it be the terrible diet? Could it be that you are sitting now at your new job more than ever. Well those questions frighten us as the answers we get back will frighten us. Because resounding reality is that they will come back as yes and then the you as the patient has work to do. You would have to decide to change. That is truly difficult.
Here is the bottom-line- UNCONCIOUSLY WE EARN OUR DISEASES , LET’S CONCIOUSLY LEARN TO UNEARN THEM.
When I have that ready patient that says “I need it and I want it” then as a doctor I need to know how to help them.
Am I equipped to do this?
Changes a Doctor needs to make
They may forget your name but they will never forget how you made them feel- Maya Angelou
Think back to what you have learnt from patients.
How many of your patients come year after year to see you, then get diagnosed with a disease — and your skill lies in diagnosing them early and keeping them comfortable with their disease. To think you do anything else different today is delusional.
Most of medical school is about understanding the disease process, following a standard of care as determined by studies that are controlled, and applying those principles to the uncontrolled environment of the patient.
This we never question and completely rely on a small batch of tests that never give us a clear picture, till it is too late. Scientific advances have been made in leaps and bounds. Yet the testing I ordered in 1993 is what insurances cover today for a routine annual physical.
A physician’s most successful journey begins with humility. We do not have all the answers. We do not know all the answers. What we do know is that chronic disease is on the rise.
People are dying longer- getting sick in their early 30’s and collecting diseases, drugs and dysfunction over the decades and we help them in this journey, by decreasing the impact of the burden of the disease.
60 to 80% of the diseases we deal with in the primary care setting are life style induced. We code them , we intervene ( biopsies, surgery)and bill and get paid for a procedure- not outcome. We are okay with it as that is the time we are given. Fifteen minutes to diagnose and treat- no time to connect , inspire and change.
Our knowledge needs to change to understand health. Our knowledge of the impact of the stress the world puts on our human body and mind has to be understood. The only way we step up for ourselves and our patients is to understand, we need to view each individual patient for who they are, not the disease they have.
Yes every complaint has a root cause. How many times we blindly treat a symptom without understanding why it happens?
A patient says “ I have heart burn at night”, and we are quick to prescribe an antacid or even worse cut out the stomach acid with a acid pump inhibiter. What if you knew that the patient eats a tub of ice cream at night , because they have stress and this is their way of coping. Imagine impacting the root cause. Yes it takes time and our medical system is not set up for this. This is why we run a scam.
Every patient is given the same treatment for the same diagnosis and we think we have done our job. As we never resolve anyone’s problem and so it gets tiring after sometime for both, us and the patient.
If I had an hour to solve a problem, I would spend 55 minutes thinking about the problem and 5 minutes on solutions- Albert Einstein
The real problem is today we have a highly informed world. We are connected and bombarded with information. The science is lost in all this noise. Everyone is an expert because they have read these conspiracy theories and it resonates with their belief system or whom they follow.
We should not confuse information with transformation.
What needs to happen to solve this?
So first, a physician must ground themselves. What science we know, we have to master. It is impossible to stay up to date on everything in this field. Have the humility to accept that.
Second look at the patient as a human being in suffering, because they lack education. So most of our time should be spent on education and teaching. Understand the problem before you throw solutions at it.
Encourage a patient to be an active participant in their own care. You cannot solve a problem they have developed over decades in 15-minute window time frame. You need their help.
Now for the patient’s responsibility — as a patient you have to understand, this system as it is set up today is responsible only for your disease. You are responsible for your health .
As a patient the problem is if you think you are powerless to solve your problem then you are right. If you feel empowered to change your life to beat a disease then you are right too. You have a choice. You always have choices. Only truth is there is no easy choice.
A therapeutic partnership between a humble doctor and a willing patient is the solution. The current design of this system will not allow it and so we get to create a new one.
It all begins with one change, one person, one step. It all begins with awareness of what does not work and how to change it.
Disease management is expensive.
Health care is not.
The perception of every doctor is that they make people better- and the perception of a patient is “I need this medication or procedure to live-”, both of which are dead wrong.
Our understanding of the medical system as it is, makes it a scam. It is not designed to make money keeping you healthy. It thrives on disease.
So, stop calling it the health care system that makes it a scam. It is a disease management money machine, and that is the reality.
dR. Nisha Chellam