Wednesday, July 29, 2009

Preventive Medicine

In the past, I have mentioned that one of the keys to fixing our healthcare system, and more importantly improve people's quality of life, is preventive medicine. I thought it might be good to share what preventive medicine means to me.

As an exercise science major I have studied extensively physical activity's profound impact on our overall health. In fact, increasing physical activity has a greater impact on overall health than any other lifestyle change. All-cause mortality is decreased by increasing physical fitness alone. This is a part of preventive medicine, but it doesn't stop there. Allow me to illustrate using a hypothetical example.

Let's say somebody has numerous gallstones which block the gallbladder and cause immense pain. This pain would lead that person to the doctor's office. The doctor assesses the situation and decides it would be best to surgically remove the gallbladder. This treatment alleviates the pain and the patient goes home happy right? Wrong. This type of medicine neglects the underlying lifestyle which caused the problem in the first place. Let's say that a major reason the gallstones formed was due to obesity. Obesity reduces the amount of bile salts in bile, thereby increasing the cholesterol content. Obesity also decreases gallbladder emptying. Now, the cause of the obesity is the person's high levels of stress, caused by their huge workload, lack of time to exercise, etc. Taking out the gallbladder still leaves the root cause untreated.

Another example is the man who comes into the emergency room with a broken arm. The doctor sets the arm in a cast and the arm heals perfectly. The patient is healed right? Well it turns out that the man has a drinking problem, he broke his arm because he was drunk and fell from his buddy's balcony. He comes into the ER a few months later with another drinking related injury.

Dr. Dan Schmidt shared another great story in one of my previous posts.

Essentially, a specialty doctor quick fixes many people's injuries, but too often the root causes go untreated. I don't really think a universal health care plan will fix this problem. How will free quick fixes give any more incentive for people to make lifestyle choices that will keep them out of the doctor's office to begin with? Preventive medicine helps people make these choices, choices such as controlling their diabetes, their weight, or their nutritional habits.

General practitioners are essential to providing this type of care. GPs see people over long periods of time. They are familiar with a patient's lifestyle and are able to better provide holistic care.

One of the things we need is more incentive for GPs to enter the medical field. Unfortunately, in the U. S., GPs make up only 13% of physicians available to help people. The U. S. is in dire need of this trend to change.

GPs make far less money than specialists and their work environment is far from ideal. Why would I choose primary care when I'll spend twenty years paying off student loans which are pretty much irrelevant to a specialist?

Obama has mentioned that he will help with primary care physicians' student loans. That would be great. Only with more primary care physicians can we really start treating the whole person, practice preventive medicine, and come up with a realistic health care system that is sustainable.