The Problem with Preventative Medicine

And so, if we are healthy, then Hospitals/Health System will not see us come through the door, and not get paid.  They thrive, financially, on the sickness.

Truly they survive financially on sickness because health insurance has agreed with the individual, and mandated to the provider, to pay to ‘cure’ sickness.

The health system wants to promote wellness, to avoid sickness, but there is no money in that at the moment.  So it’s lip service at worst, and unbillable time at best.

Once your insurance agrees with you, and mandates to the provider, that they will pay for preventative medicine and wellness, (ex. go to any gym on our plan!) then a push in the direction of decreased sickness will, plausibly, be seen.

Is there a problem with that?  Well, sure.  My health has to do with stress, sleep, economics, geography, nutrition, exercise, happiness and on and on.  So, are you willing to pay ONE company to be in charge of regulating and managing all of those things in your life?  What kind of monthly payment would you expect for a company to manage all these things?  A copay?  Now, an insurance company will surely take your money, and a Hospital / Health System will certainly take your money and provide you with stress counseling, re-location services, job coaching, marriage help, a morning yoga class, CrossFit in the evenings…  They would do it, if someone mandated it, as in current health insurance, and they would check on you every 7th visit with a progress note and give you a certain code related to wellness, etc, etc just as they do in the sickness business.

Heck, what cannot be tied to your health?  It is, after all, your life and the quality of that life.  That is certainly a wonderful argument against centralized health care; when pursued it puts government fingers into every aspect of…. Life.

So, of course, gyms exist, outside exists, organic grocers exist, pools and beautiful music and paintings exist, books on relationships and happiness exist.  There are monetary limitations to some of these, but with library access to the internet and a willingness to make health a priority, there should be no issue with the individual accessing, outside of health insurance and the health system, their own wellness.  Or did I just say it right there?  “…a willingness to make health a priority…” Yes, I believe that was the sentence that may need to be bolded.

From what I can tell; society is quicker to spend $500 on an ipad than they are to spend $20 on a copay that could improve their function and quality of life.

Let’s start anew.  Let the hospital make money on sickness, for sickness indeed exists.  Don’t listen to hospitals or physicians or surgeons about how to stay healthy… because they are influenced by the environment in which they live and work.  So we should seek out…..who? Physicians and surgeons certainly may be knowledgeable about wellness and give you the correct advice.  That is true. 100%.  The thing is, is that they don’t care enough (read: don’t get paid for) following up on whether you do it or not.  Disconnect found. Here is an example for all of life’s advisers that come along your way:  What will the barber say when you ask him if you need a haircut?  Know where the money comes from when asking questions of your provider.  Does it come from the drug company of the drug s/he wants you to take?  It’s possible.  So listen to multiple sources and take the advice that seems the least manipulated with the least strings attached. 

So, still, it becomes “…a willingness to make health a priority…” that makes the difference.  So it is truly in the hands of the individual, but as providers, we have to examine our part.  So, try as we may, since there is not a real model for those of a professional nature with expert knowledge of health to be involved enough to care how you are progressing with your “out of the office” goals they have made for you, you are left on your own to fulfill these requirements.

Let me get an example out of my head.

Physician tells patient, “eat better to cut down on that hypertension by doing x,y,z.” Great advice, no doubt.  Patient leaves; enters their previous environment and does not make health a priority.  Next visit, hypertension is not under control, Dr. Physician provides meds at a dose, says “see me soon.”  This cycle repeats with the doses changing to deal with the condition.  Patient says “I’ve got my hypertension under control.”

That seems so normal that it is hard to make a point out of it, and of course one could say “what else could Dr. Physician do?”  Sure, great question.  He gave meds, helped the person with the symptom, did the best job he could, again, no doubt. I have little doubt of the honest and true intentions of the providers.

But there was no real follow-through or interest in follow-through for the first, and most important statement: “eat better.”  A provider cares or does not care (doesn’t matter) about the outcome of that conversation because he can just prescribe some meds the next visit and still be doing his job hypocraticly.  It is my opinion that this is a failure of the health system.  Who has time to follow up with patients and make sure they do what you said, or at least put more effort into that realm of treatment?  Well, those that get paid to follow up with patients and make sure they are staying on track.  Of course the lack of the individual to act, through education or economic or mental deficiencies, is at play here, but as a health system the lack of follow up on good/expert advice only to fall back on prescription medicine when a stern warning wasn’t enough is upsetting.

As a side note, this is a strong support message for Physical Therapy, in which education outside the realm of clinical practice is common place, and there seem to be avenues in which a PT can charge and make a living in this sort of setting. In Physical Therapy compliance is a huge issue, and taken as such.  “Do this every hour” is the homework.  When it is not done, we don’t say “take these, keep coming back, you’re now on meds.”  (ps: we can’t legally do that, or some of us might!) Most often we say, “ let’s talk about what is going to get you better.”  Then we address barriers to compliance.  Often it is time, belief in the treatment, knowledge of the physiology, doing the movement correctly and enough/too much, pain, education, encouragement and mind set.

  • Providers: I put forth that this small effort in following up and keeping on a patient makes a huge difference in costs and outcomes.  Patients who do as they are advised don’t access the health care system as often, because they manage their own issues.  Put priority in our patients. That translates into patients putting priority in their health.
  • Patients: Get that free advice from the expert, pay them their copay, pay your insurance bill, and then heed the advice and keep the rest of your money and health for yourself.

Matt D

Many more problems and solutions are described here- http://www.escapefiremovie.com/

Note: None of this post should be construed as a personal attack on the positives of the medical system or individuals doing their best to treat people within the system, or an attempt to disrupt my future referral sources.  Also, there is plenty of pro-bono work and volunteering that occurs in Health Care.  Is that an obvious statement?

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9 thoughts on “The Problem with Preventative Medicine

  1. Re; Barriers to compliance. The main barrier is who we are, our habits, world view, “environment”. self image, attitude, philosophy, creativity, energy, and something else, I’m sure….
    In short, well, everything about us.
    For an individual to change lifelong habits to eat better, exercise more, do yoga, home exercise, stop smoking, drinking to excess, lose weight, and so on, in serious cases comes about generally in 2 ways.
    Number one, hit bottom. IE, heart attack, stroke, diabetes, intentionally hurt oneself , and so on.
    Number two, tiger- change your stripes.
    Hitting bottom is essentially a big wake up call. You will wake up and change or not.
    To change your stripes is really hard. To do so, you must change who you are, or more precisely, who you imagine your self to be.
    So, if you are fat, and smoke, and out of shape and have back, leg, knee pain, you can imagine yourself as a, say runner. See yourself as a runner . Visualize yourself as a runner. This is what used to be called (and may still be so called) self image psychology. So instead of, say, counting calories, i.e., thinking about food is counterproductive, I would say. Rather, if you really see your self as a runner, then you won’t want that ice cream, cigarette, 8 hours in a chair on Sunday watching the ball game.
    So, preventative medicine is hard. “Go see your nutritionist” is a tough sell. And of course, no one would encourage someone to hit bottom.
    So I vote for self image “adjustment”. Many ways to do this. Patient has to want to, and be open to concept. Then in the PT realm (I am not one), I would think regular sessions, enforcing the self image and then handing patient off to personal trainer (if for nothing else, camaraderie) is one way to go. Most folks need help and encouragement, even if they change their stripe.
    Thoughts….

    Like

    • Superb points G,
      I enjoy the point of recognizing the difficulty in changing yourself, and understanding how it might be for a patient to engage in the new behavior we are recommending.
      I think my main concerns where concentrated originally centered around payment for these valuable services… but I now see that there are many dynamics at work here, on both sides of the dollar.
      Thanks for the feedback!
      (ps: for those of you in the blog world; if your parents don’t subscribe to your blog, well…)

      Like

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