I began this blog because I was disillusioned with conventional general practice and medicine in Australia. This disillusionment was part of the reason I recently retired but is it all the fault of general practice or a more global problem of contemporary life?
After all conventional medicine saves many lives and has made great advances in the last few decades. If you have a heart attack or a stroke or serious bacterial infection, medicine can, in many cases, save your life. For many cancers now the treatments can prolong life and sometimes cure. So what do I have to complain about?
I have been a GP for over thirty years and in that time I’ve seen many changes in medical therapies yet chronic diseases continue to have a major impact on many peoples lives and mental illness seems to be at epidemic levels. Obesity, diabetes, depression, anxiety, hypertension and other chronic illness all seem to be increasing at alarming rates.
Why are we getting sicker?
Why is medicine failing to make us healthier?
Of course there are many reasons for this but the primary one is that medicine generally looks for the quick fix to treat our illnesses. Give the patient a pill or a combination of pills and that will fix things. Cut out the offending part or bombard the body with toxic drugs. Of course these treatments often work in the short term but for mental health issues and other chronic diseases they rarely make a long lasting difference. What makes us sick is often our lifestyle yet medicine has failed to address most of our lifestyle issues.
Some of these issues are related to social concerns that doctors feel powerless to address. Problems of loneliness, isolation, lack of community and too little contact with the natural world are difficult to solve. Together with poor diet, busy stressful lives and lack of activity these issues shape our health in dramatic ways. Yet many patients aren’t willing to look at these issues preferring instead the quick fix of a medication. And many doctors go along with this because there is so little time to address the core issues of why so many of us are sick.
The most significant problem is that we have not yet adapted to modern life, which leads most of us to be under chronic stress. Our diets are nutrient poor and we just don’t do enough physical activity or sleep enough. Many of us work in jobs we dislike for enough money to maintain our over consuming lifestyles. We eat too much, we do too much and we have forgotten about the importance of good relationships and community ties. We also have forgotten about our connection to the natural world and about finding joy in our lives.
So why is medicine meant to address these greater issues?
I believe that doctors should be interested in changes that lead to better health and medicating patients rarely leads to permanent change. It just greases the wheels of a huge pharmaceutical industry. Doctors need to name the problem and in many cases the problem is our addiction to our modern lifestyles. It is our contemporary lifestyles that are leading to much of our disease. There are no quick fixes but changing our lives can lead to much better health outcomes and much happier patients.
Of course people don’t need doctors to make their lives better and healthier. Everyone can make changes to their lives that will improve their health and I will write about these in a future blog. But changing medicine to help people address these issues is important. Naturopaths, traditional Chinese medicine practitioners, chiropractors and other complementary practitioners do not fail to address lifestyle issues with patients yet GPs and specialists too often just pay lip service to changing lifestyles while medicating the problem. A colleague of mine has started a clinic to help people try to cure their Type 2 Diabetes. Another clinic I have worked in has long appointments and tries to address the patient’s health holistically. Yet these are the outliers; most GPs spend 10-15 minutes with a patient and this time pressure leads to many of the problems.
The issue of course is how do we change a system that is so entrenched? I think we need to try a multi pronged approach.
First, patients need to educate themselves about lifestyle issues and their importance in treating disease. They need to demand this knowledge from their doctors.
Second, patients need to stop expecting quick fixes for chronic problems; people need to take responsibility for their health and make appropriate changes.
Third, the Medicare billing system needs to change so that there is not a financial disincentive to spend more time with patients. The Royal Australian College of GPs (RACGP) could spend more of their time and energy lobbying for these changes.
Fourth, the influence of pharmaceutical companies over doctors needs to be identified and discussed by the community and the media. Further regulatory changes need to be made to counteract the influence wielded by these goliaths.
Fifth, medical education needs to focus more on the importance of lifestyle issues. Nutrition and preventative strategies needs more emphasis in both under and postgraduate medical education.
Finally we all need to examine our own lifestyle choices and acknowledge their dramatic impact on our health and wellbeing.