The Problem With Health Care
As populations age and as lifestyle choices become ever less adequate, health care systems across the world are increasingly over-burdened. Spending on palliative health care increases each year, yet outcomes continue to deteriorate. Citizens take less and less care of themselves, and doctors have less and less time to spend with each patient as backlogs continue to grow.
It doesn’t take a genius to realize that (a) something fundamental is wrong with the way we’re approaching health care provision, and (b) we’re on a one-way path to disaster.
Fortunately we don’t need a genius to diagnose what’s wrong here. We simply need to look at the facts, understand the components of the problem, and begin to consider alternative approaches that may be far more efficacious.
Let’s begin with the core element of most health care systems: the doctor-patient interaction.
This is a paradigm delightfully stuck for our endless amusement in the Middle Ages. The doctor is the Expert and the patient is merely a fleshy bag of Symptoms. Overt power resides entirely with the doctor and the patient’s only options are (a) obedience, or (b) non-compliance.
Worse yet, the doctor has been trained to diagnose symptoms. This means waiting until the patient presents with one or more such symptoms so that the doctor can play Sherlock and attempt to deduce what the underlying problem may be. In a great many cases the underlying problem is never discovered and the doctor resorts to prescribing something that may reduce the most obvious symptoms while leaving the cause(s) unchecked.
In the USA the situation is exacerbated by the ever-present threat of lawsuits, so over-practicing and over-medicating has become the norm, thus increasing expense and metabolic impact on the patient. In the UK one queues until one is either (a) seen, or (b) dies while waiting for an appointment — which is why the UK has the lowest survival rate in Europe for skin cancer, for example.
The failings of modern health care systems are literally endless and were we even to attempt to enumerate them, this article would become a 4,000 minute read. So instead let’s look at the underlying causes of some of these major problems.
First of all, doctors are still being trained in an eighteenth-century mode of operating. Ironically the commercialization of antibiotics in the second half twentieth century briefly enabled such an approach to work occasionally as antibiotics permitted doctors for the very first time to treat certain conditions such as venereal diseases, cholera, leprosy, and various intestinal ailments. At this point doctors could diagnose acute conditions and, in some cases, actually cure them.
Unfortunately very few people these days suffer from acute diseases. Sanitation has eliminated most of them from our range of daily risk factors. Today, we mostly suffer from chronic ailments and the problem comes from the fact that by the time we present with symptoms the disease has already progressed significantly. In many cases, the progression is such that no cure is possible.
Waiting for people to present with symptoms is therefore unlikely to be efficacious. Yet we persist with it because it’s traditional and it is how doctors continue to be trained.
Worse still, the powerful doctor/submissive patient dynamic precludes meaningful involvement of the patient, yet for lifestyle-induced illnesses patient involvement is central to engineering improvements. Rendering the patient essentially powerless (except for the power of non-compliance) is a very poor strategy. We know from countless studies of effective parenting and of change management that simply telling someone what to do is one of the very worst ways of persuading them to do it. Involving people deeply in their choices is central to altering harmful behaviors. But doctors are trained to do the opposite and patients expect the doctor to be all-powerful so they automatically adopt a passive role.
This detachment from their own agency means patients are often less compliant and less proactive than they would otherwise be, which leads doctors gradually to increase their distrust of patient behavior, which in turn leads doctors to assume even more of an all-powerful role.
This is why so many covid-19 patients were accidentally killed by doctors in the first months of the pandemic. Although putting someone into an induced coma and ventilating them is known to be highly dangerous even for perfectly healthy individuals, doctors followed this protocol long after it was blindingly obvious it was counter-productive. The few brave physicians who tried to point out the folly of forced ventilation were relieved of duty and sent home because they were regarded as “disruptive influences” that were unhelpful during a time when everyone (including doctors) was panicking. Doctors simply did not trust patients to leave nasal O2 clips in place; putting them into induced coma meant they could not interfere with the protocol their doctors were inflicting on them.
It is now generally accepted that well-meaning but insufficiently thoughtful doctors killed up to 80% of early SARS-CoV2 patients in this way. Now that nasal O2 clips have become the preferred protocol, mortality rates per thousand hospital admissions have significantly diminished.
There are many, many more examples of how dysfunctional current health care systems are. Two other massive failures include the current US opioid crisis which was caused entirely by doctors over-prescribing highly addictive drugs like fentanyl; and the emergence of drug-resistant strains of bacteria arising largely because doctors took to prescribing antibiotics for a wide range of ailments not treatable by antibiotics (usually under the excuse of “well, it won’t actually cure your viral infection but it may prevent an opportunistic bacterial infection…”).
For all the talk of evidence-based medicine, doctors the world over remain psychologically closer to their witch-doctor cousins than to rational empiricists. Of course they want to give their patients magic pills. Wouldn’t you if you were faced with an endless procession of sick people day after day, month after month, year after year, all looking at you fearfully or resentfully and all hoping for a miracle cure?
Furthermore, despite popular belief to the contrary, doctors actually know almost nothing about health. Their entire training and their entire professional lives are spent focusing on illness. Ask a doctor for advice about exercise or diet or any other health-related activity and at best you’ll get half-baked ideas drawn from inadequate literature; at worst you’ll get entirely misleading and harmful suggestions.
The focus of our heath care systems is pointing in the wrong direction.
Now we have to ask ourselves: why is over half of all health care spending nowadays being incurred by obesity-related diseases? And why does nearly all the other half of health care spending occur in the last eighteen months of a person’s life, as doctors do everything feasible to prolong the lives of the very old and very sick?
An alien species visiting our world would look at this situation and find it totally incomprehensible.
The reason all these dysfunctional things occur is very simple:
It’s our own fault.
We want to believe we can live forever. We want to believe we can sit slumped on the sofa gazing mindlessly at a flickering screen for hours on end, cram ourselves with junk food, and suffer no consequences. We want magic pills and effortless results. We don’t want to accept any responsibility for ourselves.
This is why the USA is one of the fattest nations on Earth, is the most over-medicated, is the nation that spends more of its GDP on health care than any other country yet has mediocre outcomes, and is the first nation in history where people are simultaneously obese and suffering from malnutrition.
Where the USA leads, the rest of the world follows. Even the French, once famous for small portions and slender citizens, now have 40% of the population overweight and 10% of French people are obese.
As obesity dramatically increases the risk of various cancers, emphysema, cardio-vascular diseases, Type II diabetes, neurological deficit, bone fractures, tendon and ligament injuries, hormonal imbalances, and general risk of injury from falling, it’s clear the future is looking bleak.
Of course we should totally redesign our health care systems in order to make them fit for purpose in a world where more than 95% of citizens will suffer from chronic, not acute, ailments and 60% of people will die from chronic ailments. Of course we should train doctors in an entirely different way. Of course patients should become partners in the process of becoming healthier rather than being seen as untrustworthy passive recipients of a doctor’s supreme wisdom.
But these things alone will be hopelessly insufficient.
Unless we, as individuals, begin to accept responsibility for ourselves, we’ll continue to ask for magic pills and grow fatter and more indolent with each passing year. Unless we accept that we have enormous influence over our own health through the lifestyle choices we make, we’ll simply continue to become sick at an earlier and earlier age and be more and more ill throughout our increasingly miserable lives.
We need to learn that exercise isn’t a chore: it’s one of the greatest gifts we can give to ourselves. We need to learn that slumping on a sofa gawping at ersatz entertainments while cramming endless McSlop and buckets of Kentucky Fried Cancer down our throats is no way to spend the precious fleeting moments of life we’ve been gifted.
We need to start educating ourselves on the fundamentals of nutrition, even when sometimes this is difficult or confusing. We need to start thinking in terms of health rather than in terms of instant gratification.
Only babies demand instant gratification, and that’s because they are at such an early stage of development. As teens and as adults, we’re supposed to be more functional than that.
It’s time we became so.