Can You Trust Your Doctor?
When we hear the phrase, “doctor-patient relationship,” there is an almost sacred implication that brings to mind lofty images- the experience the doctor brings to bear on your medical issues, the promise of feeling better and living longer if you follow “doctor’s orders,” the comfort of having an expert in your corner when you are sick. This really is an important partnership between you and an expert that you expect to have your best health at heart. But is this the relationship you really have with your doctor?
In the United States, the medical system is among the best in the world when responding to acute illness and traumatic injuries. If you’re going to have a heart attack or a car crash, the U.S. is among the best places to be if you want fast, effective medical treatment with a high expectation of survival and even a full recovery. In fact, the reputation the U.S. medical system enjoys today is based on the amazing developments in and delivery of care for acute medical conditions- things that will kill you if you don’t act fast.
But what does our healthcare system spend most of its energy and resources on? Treating chronic illness.1, 2 And note that I said, “treating,” not “curing.” How are we doing on this? As of 2014 six in ten adult Americans suffered from at least one chronic disease, and 4 in 10 have two or more.3 The incidence of chronic illness, things like diabetes, high blood pressure, arthritis, autoimmune conditions, cardiovascular disease, among others, is increasing despite steeply rising healthcare spending.4 If we’re doing the right things, then increased spending should result in lower rates of chronic illness. We must be missing something here.
HEALTH EXPENDITURES 1960-2022
One possible explanation is that good health does not result from what happens at our doctor appointments. How much time does your doctor spend talking to you about nutrition? Or lifestyle? Other than to tell you to “eat better” or “get more exercise” or “lose some weight.” Unfortunately, the current system does not provide time for a physician to get too deep into these topics. But more importantly the current system provides a perverse incentive that leads doctors to spend less (if any) time helping patients achieve optimal health, and just focus on treating your current symptoms.
Unfortunately, our current system provides a doctor very little financial incentive to keep you healthy. What really impacts a healthcare organization’s bottom line is how many patients are seen, how many prescriptions are written, and how many procedures are conducted. And healthy patients don’t need to be seen as often, or have as many prescriptions or procedures ordered. The doctor must devote a as much time as possible to doing the things that pay the bills, and getting patients to a state of health that actually reduces revenue is understandably not prioritized.
At this point some may protest that I’m painting health professionals with a broad brush as uncaring and solely financially motivated. Having worked for much of my professional life in healthcare I can say there is nothing further from the truth. The doctors, nurses, and allied health professionals I’ve worked with over the years have consistently been hard working, dedicated, and caring. The problem isn’t with the practitioners, the problem is the system within which they work.
So what do we do about this? How do we go about improving our health and preventing chronic disease when the healthcare system seems to work against that?
First, one must become educated. This is your body, and, barring some science fiction biotech invention, it’s the only one you’ll ever have. Learn how to take care of it. Check out some books. Watch some videos. Learn how your cells work, how your metabolism works, why exercise and sleep are important. The amount of information now available at our fingertips removes barriers to learning that would have seemed insurmountable only a generation ago. It might seem easier to just “listen to the experts,” but learning how your body works is going to help you decide what advice from your doctor makes the most sense for you.
Did he just say “decide which of your doctor’s advice to follow?” Yes- we must remember that our doctor is our paid advisor, not our boss. If you’ve found a good one, it makes sense to place weight on the recommendations your doctor provides. But at the end of the day, you are the one that decides what steps you will take toward improving your health. If you staunchly follow doctor’s orders, that’s a decision. But if you have a well-reasoned question or objection to a piece of medical advice, you will have to decide which way to go. And it’s this type of situation that will tell you what kind of doctor you have.
Does your doctor dismiss your concerns and insist on their recommended course of treatment? Or do they thoughtfully discuss your concerns with you, answer your questions, educate appropriately, and respectfully accept your decision one way or the other?
Just like finding other professionals in your life (e.g., auto mechanics, contractors, accountants, attorneys) it can take some effort finding the right doctor. How open is your doctor to questions about your condition? What about their attitude towards alternative approaches? Does your doctor have a “my way or the highway” approach, or is he/she a partner in your health journey?
Finding a doctor you can trust is immensely valuable. You can read a lot of books and articles, and can learn a great deal from audio and video material online. But your doctor has had an incredible amount of education and experience in health that you can benefit from. If you can discuss what you’re learning about your condition with a doctor who respects your autonomy and is dedicated to helping you manage your health better, imagine how much you could learn. A good doctor can help you create an optimal health practice, recognize blind spots that are holding you back, and avoid pitfalls that could set you back in your journey.
To find a doctor like the one described, I have two suggestions. First, look for a physician that practices functional medicine. Functional medicine-trained doctors look for root causes of disease and focus on resolving those, rather than simply prescribing medications to alleviate symptoms. They understand that the goal is not avoidance of disease, but a state of optimal health. It may not sound like much of a difference, but in practice the results are night and day. Find a functional medicine provider at The Institue for Functional Medicine (IFM).
Being able to spend the time needed to discuss your health concerns with your doctor is vital to the success of your health journey. Time is not something that doctors have in large amounts in your typical healthcare organization setting. Enter Direct Primary Care (DPC). DPC can be described as a membership with an independent physician. For a set monthly or annual fee, a patient can see the doctor whenever needed, and the doctor can spend the time necessary to address the important aspects of the medical appointment with the patient: history, examination, diagnosis, treatment, and any questions the patient might have. DPC doctors typically do not accept insurance, so are freed from many of the constraints and requirements that traditional healthcare organizations struggle with. And DPC doctors don’t get paid more the more times you have to be seen. Since your membership fee is set regardless of how often you visit, DPC doctors are actually incentivized to help their patients achieve optimal health. Here are some sites to help you find a DPC physician near you:
• https://mapper.dpcfrontier.com/
• https://www.findmydirectdoctor.com/
Your health is vitally important, and the consequences of poor or uninformed choices are significant. You should be able to answer “YES” to the question, “Can you trust your doctor.” By doing your homework to learn as much as you can about your own health, and by finding a doctor that is incentivized to work with you to achieve optimal health, you can have a doctor-patient relationship that lives up to everything that term means to us.
Notes
1. https://www.cdc.gov/chronic-disease/data-research/facts-stats/index.html
2. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical
3. Buttorff, Christine, Teague Ruder, and Melissa Bauman, Multiple Chronic Conditions in the United States. Santa Monica, CA: RAND Corporation, 2017. https://www.rand.org/pubs/tools/TL221.html.
4. https://www.healthsystemtracker.org/health-spending-explorer/
