WRITTEN BY Dr. Nancy Palermo Lietz
Healthcare has become challenging for patients and healthcare providers. They should be the navigators of the system but because medicine has been taken over by corporations, medical care has been taken out of their hands. Costs are skyrocketing and the health of patients is declining despite a tremendous increase in spending. It is estimated that Americans will pay more than a billion dollars each year in healthcare costs.
The increase in healthcare spending is multifactorial. New technology is expensive and there is a push to incorporate it even though the necessity is unclear. Doctors order unnecessary tests and perform expensive procedures in attempts to regain lost revenue and satisfy patient’s requests. If drugs, procedures and tests are new, patients believe they need them. Doctors are not always using their expertise to counsel them otherwise. Pharmaceutical sales continue to be one of the leading drivers of increased spending and hospital costs have increased ten-fold.
The corporate transition in medicine has significantly damaged the physicians’ role. He is no longer the conductor orchestrating how care should be played out but now he is simply the musician playing what is placed in front of him. The doctor-patient relationship has declined due to time constraints and the increase in the number of patients requiring care. Physicians are paid less by outcomes and success is measured by a dollar amount. Doctors can no longer provide the care they want for their patients. Patients feel they receive rushed, impersonalized care in less time at an increased cost. Their visits are simply triage sessions designed to order tests, procedures and surgeries. What is most concerning is Americans are suffering from more health conditions and continue to be less healthy every year. They are responsible for the decline in their own health. They lack appropriate education and currently the medical office environment is not conducive to providing them the education they need.
Physicians often lack the education as well. Medical education is now funded by the very corporations that profit the most—the pharmaceutical corporations and the hospitals. Thus, medical training now concentrates on pharmaceuticals, procedures, hospital care and testing. There is little to no education on prevention of disease and nutrition. Medical corporations do not profit from prevention.
How did it get so complicated? It seems America’s medical system is as unhealthy as we have become and at the rate we are going it will be impossible to financially support this system. It seems an impossible fix and it is unclear where to start making changes. Patients and physicians must be the catalysts for change. It is unclear where to start yet the solutions may lie in teachings from thousands of years ago.
About 2,400 years ago, an early physician, Hippocrates, wrote a manual providing early physicians and patients with basic and useful information designed to provide a holistic approach to care. Though today every medical student takes the “Hippocratic oath” when receiving his medical degree, few of these new doctors are familiar with Hippocrates’s basic teachings and fewer yet put any of the principles into practice. Hippocrates teachings were clearly ahead of his time. His guidelines should serve as a foundation for the changes needed in our healthcare system today.
Hippocrates was a Greek physician who was born in 460 BC on the Greek island of Cos. At the time, he was regarded as one of the greatest physicians of his day. He based much of his writings and practice on observations of the human body and how it was affected by man’s surrounding environment. He thwarted the belief that disease was punishments from the gods and instead was a result of environmental and physical effects. He was a great believer in cause and effect. Some of his teachings are profound and ahead of his time. His teachings are well documented in the Hippocratic Corpus. The more than 70 texts found in this work are amazing. Here are a few of them that may serve as a foundation for what is truly important in healthcare.
“First Do No Harm”
(Primum non nocerum)
The Hippocratic Oath is the very statement new physicians take when they are given their medical degree. The oath was designed to ensure that new physicians were serious about their profession through their professionalism and moral standards. Hippocrates believed that doctors should be held to a higher standard, both ethically and professionally. They were encouraged to use their medical knowledge only to save a life and were expected to use their expertise to limit unnecessary procedures and treatments. They were encouraged to treat a patient as a whole, taking into account all aspects of his life. Clearly in today’s medical environment focus has moved to procedures, medications and testing. Many of these medical modalities are associated with risks and complications and are adding to the nation’s growing health care tab. The tests and procedures can be harmful as well. Medical errors are the third leading cause of death in this country. It is up to physicians to be ethical in their recommendations and not be influenced by monetary rewards. They must educate patients that more medicine is not necessarily better medicine. A United States group working with 25 medical specialties has released its recommendations in the Choosing Wisely Campaign. This campaign, launched in 2012, is aimed at helping doctors and patients navigate through more than 130 tests and procedures.
“As to diseases, make a habit of two things—
to help or at least to do no harm.”
“I will neither give a deadly drug
to anybody who asks for it nor
will I make a suggestion to this effect…”
Hippocrates believed that doctors should not be content to simply focus on the treatment of disease. He believed they should treat the patient as a whole and concentrate on causes and prevention of disease. He rarely gave his patients medicine but spent time collecting data from the patient’s lifestyle, habits and diet. Currently, pharmaceutical sales are skyrocketing. Multimedia advertising and endorsements by celebrities have prompted patients to ask doctors for prescriptions they don’t necessarily need. Some commercials reassure that bad habits are OK because there is a drug to help with the sequelae. It seems there is a pill for every symptom. And for any side effects the prescription pill might have, there is another will to treat them. Americans are told there is a fix for every diagnosis so they readily accept the treatment. Doctors no longer need to investigate the cause because there is always a pill. Unfortunately, these medications come at a cost, both financially and physically. It is estimated that 76,000–137,000 patients die every year as a result of complications of medications. More than 2 million are hospitalized with adverse reactions from them. Prescription drug abuse is an epidemic and has just recently captured national media attention due to untimely celebrity deaths. Together, physicians and patients need to use pharmaceuticals as last resorts. While there are certainly disease conditions that warrant treatment with a prescription, it is important that together the physician and patient look at all aspects of lifestyle to see what changes might improve conditions and ultimately avoid the need for pharmaceutical treatment.
“Make no pretense
Physicians don’t want to admit that they don’t have a diagnosis. They need to be brave enough to admit this to patients. Once they are content that significant disease is absent, they must resist additional testing and procedures. Physicians must encourage conversations with patients about why additional testing is not necessary and often will not lead to a diagnosis.
A United States group working with 25 medical specialties has released its recommendations in the Choosing Wisely Campaign. This campaign, launched in 2012, is aimed at helping doctors and patients navigate through more than 130 tests and procedures.
“The natural healing force within each of us
is the greatest force in getting well.”
The human body is designed with an incredible ability to heal. When given the proper tools it has an amazing ability to fight infection and disease. Most diseases plaguing Americans are related to a poor lifestyle and diet. The inflammation that develops is the body’s response to environmental toxins, processed foods and diets high in sugar and fat. Even when patients are chronically ill, improvement in diet and lifestyle allow the body to reverse the damage.
“Healing is a matter of time but it is also
a matter of opportunity.”
Hippocrates believed that the body must be treated as a whole and not just a series of parts. Modern physicians are recognizing that many diseases affect multiple systems of the body. He believed that a person’s attitude and desire to be well contributed to their outcome. Modern medicine parallels our society today. Patients want the quick fix. Most diseases occur from chronic bad habits. It is unrealistic to believe that they will improve quickly.
When approached correctly a disease can be considered a chance to change habits and ultimately improve long-term health. For example, if a patient is pre-diabetic it is easier to put them on medication and suggest they watch sugar in their diet. However, this should be an opportunity to incorporate good nutrition and life-style changes that will prevent the ultimate development of diabetes. The medication just covers up the symptoms. It will not prevent the disease or its complications. Patients and physicians alike need to seize these opportunities and with education, lifestyle accommodations, nutrition and perseverance, true health and healing will occur.
“Let food be thy medicine and
medicine be thy food.”
It is more and more evident that our diets and lifestyle are predictors of our future health. The average American eats only three to four fruits and vegetables daily. Most of these are in the form of juice or potatoes. In fact, the most commonly consumed vegetable in this country is the French fry. The recommendations are for Americans to eat at least five vegetables a day. Most researchers expand this to 10 servings a day of fresh fruits and vegetables rich in colors and phyto-nutrients. Individuals who consume a plant-rich or plant-based diet may be reducing their risk for some cancers, heart disease and stroke. The National Cancer Institute and more than 200 studies have shown that consuming at least five fruits and vegetables per day may reduce the risk of most major cancers by 35% to 50%. Fruits and vegetables contain hundreds of different compounds such as indoles, thiocyanates, and carotenoids which work together in the body to improve a number of processes. Many of these plant derived chemicals have been shown to have anti-cancer properties and have even reduce the incidence of some cancers. Diets rich in plants also significantly reduce the incidence of heart disease and stroke. There are no available pills that come close to the benefits found in fruits and vegetables.