It's time we think about healthcare differently
Before the invention of the stethoscope, doctors routinely laid their ears on chests of patients to check how they were doing. Homemade concoctions, essentially placebos, often made people feel better. Doctors visited homes of patients who would later pay them whatever they could afford. Local apothecaries sold morphine, a derivative of opium, to reduce pain. Medicine for its part was a nascent science - most of today’s diseases were yet to be discovered.
Fast forward to today, healthcare is a multi-trillion dollar industry. Medicine has branched into 120 recognized specialties and subspecialties, spinning out several industries like pharma, biotechnology, medical devices and so on with billions of drugs prescribed and lab tests performed every year. Medicine is no longer within the domain of the doctor and patient - it’s a science with ever increasing complexity.
While this advancement has helped in doubling our life expectancy in the last 100 years, the complexity of our healthcare system is hurting more than helping.
The demand for specialists is so high that they are unable to invest the time required to identify or address the root cause of why the patient has fallen sick, which could depend on factors such as the environment where she lives. Further, the patient is prescribed drugs that often have interactions with those prescribed by some other specialist, inadvertently making patients sicker. In a world of quick everything, neither the doctor nor the patient is able to go beyond fixing the problem at hand.
It’s difficult to keep solving underlying problems of sickness when the industry is paid based on the quantity of care delivered. A doctor gets paid more if he performs more procedures or sees more patients, not if he keeps a thousand people healthy. Most patients today would leave a doctor’s office dissatisfied if they aren’t prescribed a drug or made to go through a lab examination. The result is a business that wants to make a patient feel better for the short-term by doing something because that’s what the customer appreciates.
At an earlier time, patients visited doctors to fix conditions that were gross and obvious like broken hands. But now our expectations have changed. We want everything fixed so that we don’t have to compromise on our desires whatever those may be. But the more we understand the workings of our body, the more we discover how little we know. The quick-fix approach to medicine fails badly because we are trying to fix a constantly evolving target - our body.
While we spend billions of dollars on human genetics, we hardly know much about our microbiome or the genome of our bacteria. Only recently we learnt that 90% of our cells is microbial and only 10% is human. That’s 100 trillion microbial cells that we know very little about. Moreover, they are changing all the time based on where we live and what we eat. How can you then target and control what they are doing or not doing?
Health can be better influenced than fixed. There are four factors that cause disease: the patient’s inheritance, environment, physical capacity and psychological state. We don't tend to catch a cold when we exercise regularly. Our bowel movements are easy when we eat freshly cooked vegetables. We also know that we suffer body aches or fevers when we are stressed. Our body's inherent tendency is to stay healthy unless disrupted by the above factors.
I spent 20 years as a hypertensive patient popping a pill, only to discover now that my condition is reversing itself through better lifestyle and habits. While I proactively seek doctors and labs to help me track progress of my condition, I don’t use them to find a quick fix so that I can go back to lying on the couch watching TV with a pizza and drink.
As a society, we need to reflect on our mere pursuit of human longevity by using every medical means possible. The healthcare industry needs to rethink its role and simplify its approach to care. The older role entailed waiting for the patient to arrive and fixing problems based on her complaints. When we reverse those lens, the role might mean identifying precursors to problems and helping people maintain their health before they fall sick. It's time we think about healthcare differently.