Staying healthy
30/12/18 05:12
We have a medical system in the United States that is very good at treating acute conditions. If you have a broken bone or a cut or have received injuries in an accident, the medial system is efficient and treatments are effective. I’ve been following the online story of a young man who was severely injured in an airplane accident. Both of his legs were crushed below the knees with multiple fractures. His feet were badly damaged as well. He has had to endure multiple surgeries and is still wearing medical devices on both legs, but his prospects for recovery to the point where he will be able to walk again are very good. The healing that has already been accomplished, with new bone growth and precise alignment is nothing short of a miracle. It is the kind of thing at which the medical system in our country excels.
Some major illnesses that cause premature death also receive effective treatment in our health care system. The survival rates from breast cancer and prostrate cancer have gone up dramatically in my lifetime. The side effects of chemotherapies are being managed and radiation treatments are becoming more precise and effective. After investing incredible amounts of funds into research, treatment for these diseases continues to show promise and people are experiencing remission and high quality life after receiving these diagnoses.
Our medical system, however, is less adept at treating chronic conditions. I know of a lot of stories of people suffering from life-long conditions such as diabetes, heart disease, various types of arthritis who have struggled for years with inaccurate diagnoses and ineffective treatment. They find themselves labeled by the diagnosis when it comes to their interactions with the medical community. They feel that health care professionals discount their reports of symptoms. They receive generic treatments and are chastised for complaining about their suffering. Instead of receiving specific care for the particular symptoms they are experiencing, they are given broad reaching medications that might not have any impact on their specific sufferings and often aren’t that effective at treating their long term conditions, either.
For example, doctors know that increased levels of cholesterol are associated with increased risk of heart attack and stroke. Since cholesterol can be measured with a simple blood test, most adults seeking medical care are tested. When high levels of cholesterol are detected, drugs called statins are frequently prescribed. There is strong medical evidence that statins are effective in lowering cholesterol. The side effects of the medications are well known and they are widely prescribed. Physicians use a bit of statistical deception, often deceiving themselves as well as the patients. Since high cholesterol is associated with heart disease they convince themselves and their patients that lowering cholesterol is effective treatment for heart disease. However, while statins lower cholesterol, there is far less evidence that they have much impact on the long term risk for heart disease. Statins have a much lower statistical effectiveness when the criteria is long term heart outcomes. Using statins to lower your cholesterol does not substantially reduce your overall risk of heart disease. Furthermore, long term use of statins is associated with a rise in diabetes, which is another chronic disease that can have an effect on heart health.
The entire process is complex and no one should change their medical treatment based on this journal entry. The point I am making is that our health care system is less adept at treating chronic conditions than it is at treating acute medical situations.
A little over a year ago, the results of a major British study of the overall health of people who are treated in their health care system were released. Among the findings of the study was that loneliness is a major factor in the overall health of British citizens. While the study was specific to Britain, I suspect that its results could be replicated in our country as well. The study’s authors reported that “loneliness is as harmful to health as smoking 15 cigarettes a day and affects nine million UK people.”
If you let that sink in for just a minute. It is entirely possible that doctors could prevent more premature death and provide more help by treating a symptom that doesn’t require a blood test to detect. Instead of going after hidden conditions like high cholesterol, treating visible conditions like loneliness might be far more effective in reducing suffering from heart disease.
That, of course, would require physicians to begin to trust what their patients say. There are many who do not. They believe that lab tests and clinical analyses are more trustworthy than the people who live in the bodies they treat.
Patients end up being caught in the system. They experience symptoms and seek relief. Their interactions with the health care system discover new conditions that are treated. In many cases patients are experiencing no distress and no systems, but present for preventive care and find themselves taking multiple medications because of some hidden condition that was discovered only by routine tests.
To add to the problem routine tests are no where near as accurate as physicians believe. A good example is a blood pressure reading. Research has demonstrated that a blood pressure reading taken from a patient who is seated and who has been seated for less than 30 minutes is virtually always inaccurate. Yet taking blood pressure as soon as the patient is seated in the exam room is routine in most physicians’ offices. That means that there are millions of people who are being treated for hypertension (high blood pressure) based on a test that has been proven to be inaccurate.
Physicians could address both loneliness and inaccurate blood pressure readings by taking time to listen to patients before ordering any diagnostic tests. But that would mean seeing fewer patients per day and would change the financial reimbursement levels for physicians. Doctors don’t get paid for treating well patients. They don’t get paid for keeping you well. They only get paid when you get sick and they order treatment.
I’ve little doubt that spending time with my grandchildren is far more effective in terms of long term health outcomes than a visit to a doctor. I’m not eschewing modern medical treatment. I’m just saying that for long term health it takes more than visiting a doctor’s office.
Some major illnesses that cause premature death also receive effective treatment in our health care system. The survival rates from breast cancer and prostrate cancer have gone up dramatically in my lifetime. The side effects of chemotherapies are being managed and radiation treatments are becoming more precise and effective. After investing incredible amounts of funds into research, treatment for these diseases continues to show promise and people are experiencing remission and high quality life after receiving these diagnoses.
Our medical system, however, is less adept at treating chronic conditions. I know of a lot of stories of people suffering from life-long conditions such as diabetes, heart disease, various types of arthritis who have struggled for years with inaccurate diagnoses and ineffective treatment. They find themselves labeled by the diagnosis when it comes to their interactions with the medical community. They feel that health care professionals discount their reports of symptoms. They receive generic treatments and are chastised for complaining about their suffering. Instead of receiving specific care for the particular symptoms they are experiencing, they are given broad reaching medications that might not have any impact on their specific sufferings and often aren’t that effective at treating their long term conditions, either.
For example, doctors know that increased levels of cholesterol are associated with increased risk of heart attack and stroke. Since cholesterol can be measured with a simple blood test, most adults seeking medical care are tested. When high levels of cholesterol are detected, drugs called statins are frequently prescribed. There is strong medical evidence that statins are effective in lowering cholesterol. The side effects of the medications are well known and they are widely prescribed. Physicians use a bit of statistical deception, often deceiving themselves as well as the patients. Since high cholesterol is associated with heart disease they convince themselves and their patients that lowering cholesterol is effective treatment for heart disease. However, while statins lower cholesterol, there is far less evidence that they have much impact on the long term risk for heart disease. Statins have a much lower statistical effectiveness when the criteria is long term heart outcomes. Using statins to lower your cholesterol does not substantially reduce your overall risk of heart disease. Furthermore, long term use of statins is associated with a rise in diabetes, which is another chronic disease that can have an effect on heart health.
The entire process is complex and no one should change their medical treatment based on this journal entry. The point I am making is that our health care system is less adept at treating chronic conditions than it is at treating acute medical situations.
A little over a year ago, the results of a major British study of the overall health of people who are treated in their health care system were released. Among the findings of the study was that loneliness is a major factor in the overall health of British citizens. While the study was specific to Britain, I suspect that its results could be replicated in our country as well. The study’s authors reported that “loneliness is as harmful to health as smoking 15 cigarettes a day and affects nine million UK people.”
If you let that sink in for just a minute. It is entirely possible that doctors could prevent more premature death and provide more help by treating a symptom that doesn’t require a blood test to detect. Instead of going after hidden conditions like high cholesterol, treating visible conditions like loneliness might be far more effective in reducing suffering from heart disease.
That, of course, would require physicians to begin to trust what their patients say. There are many who do not. They believe that lab tests and clinical analyses are more trustworthy than the people who live in the bodies they treat.
Patients end up being caught in the system. They experience symptoms and seek relief. Their interactions with the health care system discover new conditions that are treated. In many cases patients are experiencing no distress and no systems, but present for preventive care and find themselves taking multiple medications because of some hidden condition that was discovered only by routine tests.
To add to the problem routine tests are no where near as accurate as physicians believe. A good example is a blood pressure reading. Research has demonstrated that a blood pressure reading taken from a patient who is seated and who has been seated for less than 30 minutes is virtually always inaccurate. Yet taking blood pressure as soon as the patient is seated in the exam room is routine in most physicians’ offices. That means that there are millions of people who are being treated for hypertension (high blood pressure) based on a test that has been proven to be inaccurate.
Physicians could address both loneliness and inaccurate blood pressure readings by taking time to listen to patients before ordering any diagnostic tests. But that would mean seeing fewer patients per day and would change the financial reimbursement levels for physicians. Doctors don’t get paid for treating well patients. They don’t get paid for keeping you well. They only get paid when you get sick and they order treatment.
I’ve little doubt that spending time with my grandchildren is far more effective in terms of long term health outcomes than a visit to a doctor. I’m not eschewing modern medical treatment. I’m just saying that for long term health it takes more than visiting a doctor’s office.
