The difference between health care and disease management

It’s no secret that America is suffering from a huge crisis in healthcare. As we watch the sun rise on Obamacare, doctors, patients, insurance executives, hospitals, small businesses and legislators alike stand agape. No one seems to have found a simple, logical solution.

The solution is in fact very simple. It’s so ridiculously simple, it might make one laugh. And, believe it or not, it’s also amazingly cheap.

But because of its simplicity, it will also be the most difficult thing for America to implement. The disease-focused paradigm that’s been spoon-fed since the 1940’s and helped build a $2.8 trillion dollar “health care” industry will stand in its way, because it requires a profound change in our belief systems.

Let’s examine this idea from its beginnings and follow it to its logical conclusion.

Our beginning lies in our ability to first clearly define and understand the terms “health care” and “disease management.”

The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” That sounds easy enough to understand. But let’s move on to today’s entry point to health care.

Most people would go to a doctor for a health check-up. When they go to a doctor’s office, what is the first thing the patient will likely experience? Most physicians are trained to begin by taking a set of vital signs (blood pressure, temperatures, weight, etc.). The physician would then talk to their patients about any symptoms they’re experiencing. If the patient has symptoms, the doctor matches those symptoms to a disease classification system. He will then order tests to prove the presence or absence of disease.

If there is no disease on symptomatology, blood or image testing, what does the doctor conclude? Likely, the doctor would conclude that his patient is healthy by virtue of the fact that there was no disease detectable.

But go back to the definition of health by the WHO. Do these actions of a doctor actually fit with this definition of health?

It seems that searching for the absence of disease does not serve well as a definition of health. And yet this is exactly what physicians have been well-trained to do. In fact, doctors hold the default entry point to the determination of our health status — the proverbial health check-up.

Let’s return to a doctor and his or her training. Once a patient has been found to have a disease, how would that doctor typically treat his or her patient if the symptoms were significant to the patient? Most people would say that the doctor will recommend some sort of prescription to alleviate his patient’s symptoms; either an over-the-counter or dispensed drug. In the action of recommending a prescription (and perhaps some lifestyle changes to go with), what is that doctor doing?

By definition, the doctor has found a disease to diagnose, and is now managing the disease. In other words, the doctor is an expert at “disease management.”

If we look at medical training, it begins in a cadaver lab with the study of anatomy in dead people. From the reference point of death, a doctor then graduates over the years to studying diseased “specimens” in the hospital.

Once in practice, the doctor then continues to examine more and more disease. If the person comes in without disease, the doctor is trained to find a diagnosis that he can begin with, by virtue of his training. It’s relatively foreign to most physicians to begin inside a paradigm of optimal health, despite a patient’s disease labels, and continue “health care” without recommending any prescriptions, tests, procedures or specialty referral (disease-management).

So, after this analysis, we return to our basic question. If a conventional doctor is an expert at disease management and the definition of health is not merely the absence of disease, but this doctor works to determine the absence of disease … why are we convinced that we need to see a doctor as the entry point to make sure that we are all healthy?

Wouldn’t it make much more sense to see a different health practitioner, one who works inside a paradigm of health despite clinical diagnoses, before we see the expert at disease management?  What then becomes our definition of health, right here in the US, with its fast failing health care system?

Changing this singular belief system has the potential to shave billions of dollars off a disease-focused health care industry, obliterate the “shortage of physicians” crisis, and correct epidemics of modern day, chronic disease. It can be done in the course of a blog. But, it will also be the singular most difficult thing to actually accomplish in America.

A ridiculously simple solution is right at our fingertips. There’s no need to panic, as we all are doing right now. All we require is a basic differentiation between the terms “health care” and “disease management” and then we can put each “player” into their respective roles which best fit their expertise. Mastering this concept is the first step.

So here’s a quick self-check to see where you stand on this matter.

A 52-year-old male comes in to his doctor with mild joint pains in his knees, hips, low back and shoulders. He does not take any medication nor does he have any other symptoms or diseases. Assuming all his tests are normal, what is the first prescription his “health-focused” doctor should write (based on evidence)?

Your answer will help you determine the paradigm that you operate within, and also whether you are indeed a health care provider, or a disease management expert.

Natasha Deonarain is founder, the Health Conscious Movement. She is the author of The 7 Principles of Health and can be reached on Twitter @HealthMovement

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  • a dn

    A prescription for exercise of course. We discussed this elsewhere on Kevin MD.

  • Anthony D

    “It’s no secret that America is suffering from a huge crisis in
    healthcare. As we watch the sun rise on Obamacare, doctors, patients,
    insurance executives, hospitals, small businesses and legislators alike
    stand agape. No one seems to have found a simple, logical solution.”

    You can’t go to a body shop and make them repair your car if you don’t
    have money to pay.. But you can go to a hospital, get care and not pay..
    Well, YOU might not pay! But anyone with insurance has been paying with
    higher premiums. It’s really that simple.

    • Wayne Caswell

      There’s a lack of competition and comparison shopping, partly because you can’t really shop around during a heart attack. But that’s also because many hospitals don’t disclose their “secret” charges up front and send multiple bills over weeks or months after the procedure. The Centers for Medicare & Medicaid recently published average costs for common procedures from many institutions, and I encourage more of this transparency.

      Obamacare aims to encourage competition among insurers who can no longer deny or cut off coverage due to a preexisting or expensive condition. They can no longer only serve the most healthy people and must spend at least 80% of premiums on actual health care rather than administration, marketing, or profit. So how else can they control expenses and manage profits? I’m encouraged by new emphasis on wellness programs that go beyond self-insured corporate clients. If robust competition does not result, then the government could always open the public option with the ability to buy into Medicare.

      The U.S. healthcare system is starting to see stiff competition from medical tourism, and some insurers are even starting to pay for it, so our providers need to become more competitive themselves.

  • Anoop Kumar

    Couldn’t agree more. As long as we teach disease more than health and discuss disease more than health, we won’t improve the health of the nation no matter how finely we tune healthcare. Health is the solution to healthcare.

  • ErnieG

    I agree with the idea that physicians are not “health” care “providers” but rather medical disease managers. We are taught to take symptoms and signs, and diagnose (or not diagnose) disease. Given that the management of disease is difficult in itself, and takes years to practice and perfect, I also do not think that physicians need to change from disease managers to health care providers, so in some sense I agree that a different type of “health practitioner” is important. I am not so sure though if the first person you should see is this type of “health practitioner” (in a sense many already exist as alternative medicine practitioners) because I think organic disease should be excluded, or at least after some time of continued symptoms.
    In response to your question- you did not include anything about a physical exam. But I assume BMI, vitals and exam are normal. If so, I would probably ask him about mood disorders, sleeping habits, stress, diet, and exercise; assuming these are OK, I would refer him to a Paleo diet/lifestyle book that discusses diet and exercise and other aspect of health.

  • drjoekosterich

    Good observations. The problem of a disease system masquerading as a health system is not unique to the USA.

  • Kate Gilbert

    So true, but it would also need major public re-education to wean people off their addiction to medicine. Yesterday I was on a ward where a patient asked her consultant for an operation to remove her internal abdominal fat, rather than change her lifestyle to eat better. This was a woman who had just learned that in all other respects she was perfectly well.

    • Wayne Caswell

      Maybe part of the solution is to ban consumer advertising of prescription meds that all end with “Ask Your Doctor,” since the doc often then complies with their request. As far as I know, the U.S. is the ONLY country that allows this.

  • Wayne Caswell

    ‘Very tactfully written. Thanks. I’m encourage by what I see as a growing interest in nutrition, health, wellness, and “Integrative” medicine. I prefer terms like Integrative, Complementary or Holistic over Alternative, because they seem less adversarial to modern western medicine.

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