Getting Personal With Medicine

As you know, one of the aims of the second half of my career is making medicine available and understandable to everyone. That is the reason I wrote How To Think Like a Doctor and Como Pensar Como un Doctor, and the reason I am here in Nicaragua teaching medicine to providers at all levels of experience. It is also one of the reasons why I write this blog.

One problem with modern (Western) medicine is that we physicians tend to treat individuals as groups of people. Medications are tested on large populations; they are approved for mass consumption; and side-effects are noted for "common" reactions. Not all medical traditions treat people like this. Chinese and Indian  medicine (Ayurvedic) for example, take an individualized approach to health care. In other words, what works best for YOU?

We used to tease that Rheumatology was the discipline of treating the untreatable. Which means people were dosed with medications that caused HUGE problems, like corticosteroids and non-steroidal anti-inflammatory drugs (NSAID's). Don't get me wrong: I love Western medicine and I'm impressed with modern medical technologies. What I don't like is the shotgun, or in the case of the U.S., cannonball approach to therapy. And secondarily, I don't like being told by mainstream physicians and the government that that is the only way to treat people.

That is now going to change. It first started in the 1990's or the "Decade of the Brain" when neurologists and psychiatrists decided to focus on what happens inside our heads in addition to what we manifest as speech and behavior. This line of research continues at such places as the Amen Clinics, where therapy is prescribed only after a definitive diagnosis is made, only after a full history is taken (including input from family and friends), and a full physical exam is performed. Additionally, brain-imaging studies are now used to narrow down the possible diagnoses, and the patient can then be treated with the medication, dose, and timing specific for THAT individual  patient.

Which brings me to the crux of today's blog. A friend of mine works at a company that uses genetic tests to determine proper medication use for a whole host of "regrettable maladies," from breast cancer to depression. Yes, depression. Remember Dr. Mangold's Rule of Psychiatry: in the long run, psychiatric problems are neurological issues. Check out the site if you can. They are located at http://www.pgxlab.com/about/. Print up their brochure and bring it to your doctor if you think you can benefit from their testing. Make sure your doctor is listening.

The One Good Thing About ObamaCare

I'm not a fan of the Affordable Care Act for many reasons, not all of them political. Essentially, I don't think politicians and bureaucrats should be making medical decisions. Some day I will write about this in more depth but today I want to let you know about the one thing I do like about ObamaCare.

As the program develops, hospital systems (face it, hospitals as we knew them are dead) will be forced to see more and more patients and get paid less and less to see them. Right now, a hospital system or clinic would be lucky to receive 20 cents on the dollar billed. That is not due to over-billing in the first place but rather to the fact that reimbursements are approved or disapproved by bean counters pouring over charts and converting a human activity, a sacred encounter between doctor and patient, into numbers. A lot is lost in the translation.

Remember these facts and you will begin to understand how health care works in the U. S: it's all about motivation and intention. A physician or nurse is motivated by two factors: the profit motive so that they can feed their families and enjoy a decent quality of life and making people better. Sometimes the two motives pull the same weight within an individual practitioner while in another one or the other motives is more important. Sometimes they change rank depending on the provider's personal and professional circumstances.

A hospital system on the other hand is motivated first by the profit motive (hell, maintaining the CEO's pool is expensive) and secondarily by image. While the first is never mentioned in public, take a look at the ads hospitals pay tremendous fortunes on and see for yourself. "Our hospital performs the most heart surgeries in the state;" "Our hospital has a 5-star rating in ..." and so on. Changes occur when hospital systems feel that their profits or images are at stake.

Lastly, the government-run insurance programs are motivated by two factors: saving as much money as possible and providing members with access to health care that is adequate at worst and exemplary at best. The former explains why we see only twenty cents on the dollar but it will also explain why I think something good is going to come out of ObamaCare. It can be summed up in one phrase: preventive care.

My friend, economist and financial adviser John Mauldin writes with a style and clarity that can only be described as inspiring. I'll give the link to an article that describes how the ACA is going to force hospital systems to change in order to stay in business. I'll let John delve into details. What I find ironic (and sad) is that we have been saying the same thing for the last 23 years. Preventive care saves lives and money in the long run. With very few exceptions (and you know who you are!), I feel like I've been preaching to the wall. But with the weight and influence of large hospital systems, the message will reach the masses.

Briefly, consider the cost of treating a patient with heart disease compared to the cost of teaching people how to eat and exercise in order to prevent heart disease. Again, a large segment of the adult population suffer from Metabolic Syndrome which is earmarked by obesity, hypertension, and insulin resistance. This Syndrome inevitably leads to Diabetes Mellitus II and all of its dangerous complications such as heart disease, circulatory problems, mental health issues, and more. I personally have gotten patients off of cholesterol and diabetes medications through diet and exercise alone. At the front end, this saves money on medications and in the long run, saves money on more intensive interventions such as surgery and expensive drugs.

Someday I'll write about what you can do right now to experience better physical and mental health without resorting to medications and surgeries. On your part, please look at Mauldin's article and understand why I have hope for the future.
Dr. Mike
http://www.mauldineconomics.com/editorial/thoughts-from-the-frontline-the-road-to-a-new-medical-order

HOW TO THINK LIKE A DOCTOR

It's 3 am Thursday morning and I just finished my first book with the above title! Who should buy this book when it is published? Anyone who has ever been a patient. Anyone who has never been a patient. All med students, NP's, PA's, EMT's, Paramedics, and MA students. And those scared of doctors like children and hospital administrators.
Also for anyone who has walked into a clinic, saw the doctor, then walked out thinking "what the hell just happened?
If you think in your own mind that you "know better" than your physician, then read this book and show her the error of her ways.
Read this book then begin to use it like a medical journal of your own health and wellness. Did Dr. Pitel do all the things a good physician does as explored in the book or did he leave something out that Dr. Mangold said should have been done? Or did the medication Dr. Poofandsmoker from Hartford Hospital give you match up with your story and his six minute exam? Did he explain side-effects and med interactions with you or did he punt that off to the pharmacy tech instead?
So please pass on the word. It will only be published as an eBook available at amazon.com for a very reasonable rate. Click on the amazon link to the right to take you there.
Comments and criticisms are welcome but may make me cry.
Thanks all. Get out the word.