OPINION
A SECOND OPINION
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Health Care is in Crisis : A Hopeful Vision for the Future
I always knew I would work in health care . I viewed it as my “ calling ” and never entertained the idea of an alternate career path . Unfortunately , medicine turned out to be nearly unrecognizable from what I imagined when I daydreamed about it in my younger years . Part of this is due to my youthful idealism and naivete at the time , but the more significant contributor is the unfortunate decline of our “ health care ” system .
In many cases , I would argue that our system is not a “ health care ” system at all . While there are some downright miraculous aspects of modern medicine , when it comes to the prevention and treatment of chronic illness , our system is a “ sick system ” that profits from chronically ill patients . As an internist , my days are spent caring for patients with diseases with roots that can be traced to lifestyle factors – extremely unhealthy and ultra-processed American diet , lack of exercise , chronic stress , environmental toxins , socioeconomic disparities , the lack of mental health care access and the lack of support for families . As a population , we are suffering from a metabolic disease epidemic ; we are unhealthy down to our cellular components . I will never forget when one of my patients came back from a two-week trip to Italy and noted that her chronic constipation , bloating , chest pain , anxiety and fatigue almost completely disappeared while she was out of the country . She ate all the decadent pasta and sauces , drank wine and walked everywhere . Within two days of returning to the U . S ., her chronic symptoms returned , and she was back to feeling miserable and taking various medications in hopes of relieving her symptoms .
Unfortunately , many , if not most , physicians have little incentive or time to delve into the root causes of why people are becoming sick
by SUZANNE MCGEE , MD , FACP
and staying sick . It is frequently the path of least resistance to treat a problem with a medication , order a consult or even a procedure instead of sitting down with a patient and delving into the many factors that affect health and well-being . I have become increasingly frustrated that medications and procedures appear earlier and earlier in someone ’ s treatment plan , rather than preventive medicine interventions and lifestyle changes . So many patients suffer from underlying inflammation and metabolic dysfunction , and yet we do not have time to search for and address the “ why .” This frequently leads us to only treat symptoms as opposed to addressing the many root causes of illness .
While scrolling through social media , I found an unfortunate meme depicting a cartoon character crying over a casket . The caption : “ My boss crying at my funeral : ‘ How could you , we are short-staffed today ’” and a sub-caption , “ Your productivity will be sorely missed .” Now , more than ever , many physicians feel less and less like trained healers and more like money-making pawns or “ providers ” in the system . If one follows the Physician Community on Facebook , one will see posts on this topic almost daily . For me , the lack of time with patients has made it increasingly difficult to practice medicine in our fee-for-service system . The lack of time stems from several factors . Our system has a “ keep ‘ em moving ” mentality to see as many patients as possible in as short a period as possible , often with as few resources as possible . Relative value units ( RVU ) have become the main form of currency to quantify the worth of a physician ’ s work , and these units of value live up to their name . They are indeed quite “ relative ,” in my opinion . Dr . Sallie Permar , chair of the Department of Pediatrics at Weill Cornell Medicine in New York , notes in a Time Magazine article that the Relative Values Update Committee favors services like surgeries rather than non-procedural evaluation and treatment . She notes :
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