Problems of the developed world
The developed world and countries with first world health problems face difficult challenges in the future of healthcare. I believe that both the task of doctor and patient must change in order to face these current and growing challenges. Some of the major problems we face are those having to do with metabolic syndrome, including obesity, hypertension, high cholesterol, and diabetes. Other major problems I see involve issues with our mental state, including stress and fatigue (this can be both physical and mental). In most cases, these problems can be prevented and avoided completely with a healthy lifestyle. Millions of people around the world are facing these problems in record numbers and it is literally killing them–isn’t there something that we should do to change this?
From my observations of healthcare workers and their patients, I have seen many people come to the doctor complaining that they are obese or overweight, can’t get pregnant, are depressed, and feel too tired to do anything but eat and watch TV (and many are young or raising families with similar habits and problems!). I will offer my readers a common scenario of a consultation in India to demonstrate the situation (we can assume other countries with first-world problems have similar scenarios).
Observing a consultation at a women’s health camp
The doctor looks at the patient’s chart, complete with various test results. She sees that the patient has high blood pressure, high cholesterol, a BMI of 33 (the same as the patients age), and is borderline diabetic. The patient also complains of fatigue and depression. The doctor then asks the patient, “What do you eat? And what do you do for exercise?”
The patient replies with pride, “I have Kelloggs cereal for breakfast–the advertisements on TV say that it’s a balanced breakfast and a great way to start my day and might even help me lose weight (with 45 g of refined sugar and less than 1 g protein)! Then I have fried such and such for lunch and then go with my family to the buffet (oil, fried food, starches, fatty meats, sweets) or order pizza for dinner. I sometimes skip breakfast or other meals as I am trying to lose weight but I know that I am eating a healthy diet.”
A 1998 Kelloggs ad (above) and the actual “Fat Controller” (below)
The doctor then has a difficult task of trying to re-teach someone to eat as many people, including many doctors, don’t actually know what healthy eating is. And, the doctor must do this in a way that both does not offend the patient and encourages the patient to actually take action. Unfortunately, this task is made more difficult because the patients receive their education on “healthy” eating from advertisements that try to sell them processed chemicals instead of food, with images of smiling, happy, and healthy families. And Kelloggs even tells them that eating their processed starchy and sugary cereals will help them lose weight. But the doctor says–“Eat fruits and vegetables–five portions a day!” “Cut down on processes carbohydrates and starch.” “Stop eating so much meat.” “One liter of oil per person per month.” “No sugar!” “Get your friends and go walking for half an hour a day.” “Get some exercise, you will feel much better!” “By this time next year, with healthy eating and exercise, your weight will be normal and we can see what sort of problems you DON’T have.”
The patients almost uniformly reply:
“Doctor, I have no time for exercise or healthy eating (with a maid doing all the house work and the patient getting in no less than five hours of quality TV a day). I’m overweight, tired, and depressed. Isn’t there some sort of pill you can give me to help with all this? Or maybe some kind of surgery?”
I was shocked to hear that patients would rather suffer the risks and recovery of surgery, let alone the side effects of drugs, than make simple, healthy changes to their lifestyle. Then I realized that the majority of patients view their own health as completely out of their control or responsibility.
At this point, I remembered that I was once in a similar situation with depression (another complex problem that I believe can be solved with a great amount of effort and lifestyle changes). In my teenage years, I was deeply depressed and perhaps jealous of all the drugs that my friends and classmates were taking. The depression was so bad that I didn’t sleep for days and couldn’t attend school for a semester because I physically and emotionally couldn’t. I was fifteen and begged my parents for drugs. But, they didn’t believe in psychiatric medications and no matter how hard I cried and begged for a pill to make all my problems disappear, my parents didn’t budge. They did, however, settle on a two-week prescription of Ambien to restart my sleep cycle (which worked and was actually a key part of my road to recovery). But, without the intervention of allopathic medicine, somehow (with a lot of contemplation and exercise), I came out of the depression and spent the next several years of my life learning how to never let it happen to me again.
From this personal experience, I learned many things including these three points. One, it is always easier not to take responsibility for our problems and much easier to take a magic pill that “makes everything go away” rather than put in the effort to actually make our lives better. Two, drug or medical intervention is sometimes necessary (or even a key part of the solution). Three, good health (both physical and mental) takes effort and there is no magic pill (allopathic or otherwise) that can make everything better.
This experience also caused me to empathize with the patients that I saw and with people around the world facing similar problems. I understand that change is hard and it is difficult for us to accept that we haven’t always been making the best decisions for ourselves. But, instead of taking responsibility for our own lives, we make excuses and try to place the burden of our problems onto someone else (in this case, the doctor).
Some people actually view this as the solution to obesity and diabetes!
Doctors exist for a reason. They are meant to listen to our problems, identify the underlying causes, help us find solutions, and guide us on our journey to better health. However, in the majority of problems that we are seeing today, doctors and the drugs that they prescribe are (often) not the solution. Thus, our idea of healthcare must change to include and emphasize the responsibility the patient has for their own health–and not just in the sense of drug compliance (will the patient take this drug 3x per day after food as prescribed?). Patients must learn to take some responsibility for their health in terms of healthy eating, exercise, and preventative medicine. However, in order to do so, patients (meaning the general public) must to be educated in such matters by someone other than advertisers. This is where public health must make an effort. Parents should be educated on healthy eating and raising a healthy family, and schools and hospitals should be required to serve actual food (and the government should stop subsidies to shit and instead support small farmers who deliver fresh and nutritious fruits and vegetables). People should also be encouraged to look at their lives and look for areas where they can simplify and reduce stress, which I believe is a root cause of many of our health problems (including depression, insomnia, hormonal changes, stress eating leading to obesity, high blood pressure…) And, our doctors also need to set good examples for the population by living healthfully and avoiding (at least visibly) living out of the vending machine.
People need to learn that both health and happiness take effort, at least at first. Patients must realize that to some degree, their health is in their own hands–and the doctor must be used as a tool rather than as the solution. This proposed change in the way healthcare operates takes effort on both doctors and patients. Doctors must learn to think beyond drugs and learn how to reach patients in a way that encourages them to lead healthy lives (and public health must help support the doctors!), and patients need to start looking inward for better health. Medicine isn’t just about tablets and surgeries, and its time we realized it.
Note: I understand that many people have problems that do require drug intervention, including people with problems related to metabolic syndrome and depression. I am just hoping that the future of healthcare places more emphasis on health and education as I believe that in the majority of cases these problems can be prevented or, in some cases, solved with a healthy lifestyle. Change is hard and patients need empathy and help (from a knowledgeable source) along the road to better health.