We physicians live in the shadow of rising health care costs. Hospitals want us to cut length of stays and somehow become more efficient. Insurance companies ask us to accept less money for patient visits, forcing us to see more people in fewer hours. The government wants us to check a slew of electronic boxes to prove that we’ve performed what they deem to be best practices, even though there is little evidence that any of this clicking and cajoling leads to better patient outcomes. There have been lots of changes, but little-improved quality of care. If anything, the new medicine has separated doctor from patient by subverting the very essence of healing: the therapeutic relationship that makes successful treatment possible.
The current system asks us to do more with less, as if a sleeker business model will magically create wellness. Unfortunately, medicine conforms poorly to the kinds of efficiency strategies that succeed in the corporate world. As we move ever closer to a business model for medicine, we increasingly blind ourselves to the fact that medicine is actually an art. Modern practice asks doctors to paint a portrait in 10 minutes and use only the colors and shapes that others have deemed most effective. It is no wonder that the product is medical care that reminds us of bad hotel art.
I am not naïve enough to think that any of this will change. We will continue to focus on how we providers can somehow do medicine faster and cheaper. But a much larger issue is rarely discussed. How can we get people to rely on the health care system less? Here, there is one largely ignored intervention that could have enormous positive effect. A simple, central shift might occur if we would only commit to comprehensively educating young Americans about the workings of their own bodies.
In a lecture I give to community groups, I show the audience a car and ask for a show of hands by those who know where the muffler, the pistons, and the hubcaps are located. Everyone knows where these basic auto parts are found. Next comes a slide of a human being. How many of the audience can locate the position of the liver, the spleen or the pancreas? Very few hands go up. It’s quite incredible, but it’s a simple truth that we know a great deal more about our cars than about our own bodies. Why is this?
In the past, people had fewer diagnoses and took less medication. They did not live as long nor have complex technologies available for treatment. In that simpler world, we essentially outsourced the care of our bodies — and the knowledge of bodily processes — to our physicians. These were doctors who knew us well, often for a lifetime, and who were our trusted allies. Care was generally provided by a single physician with occasional specialty consultation. In a very real sense, we looked at our bodies as vehicles and our doctors as skilled biological mechanics with our best interests at heart. We no longer have the luxury of maintaining that perspective.
In today’s complicated medical environment, an understanding of who we are and how we work completely underlies any ability to create a healthier population. The old paradigm was simple. Our doctor-mechanics would “fix” our problems with pills and surgery. But today, the number of possible tests, medicines and available interventions means we will likely find ourselves sucked into a chronic relationship with the health care system. Instead of being treated by trusted friends, we find that we ourselves have been outsourced; farmed out to a series of specialists, testing centers, and ancillary providers. In that maze, health costs rise. Worse, we are poorly known to anyone and are apt to become victims of poor, impersonal care. If we don’t know enough to advocate for ourselves, there is simply no one else who will.
Creating a society that values staying at peak health and views medical intervention as a rarity rather than a regularity is absolutely key to cutting health care spending. We have done a poor job of it. Our bodies are the conduits through which we see, understand, and navigate the world. We are literally nothing without them. Yet for most of us, these bodies remain a mystery, too difficult to comprehend and too easily and comfortably ignored.
In order to begin changing the way Americans view doctors and medicine, we must start by changing the paradigm for our youngest citizens. This begins with full disclosure. We must commit to an education system that values teaching our children the details of how their bodies work and, perhaps most importantly, how disease develops, what it looks like, and what they can do to tip the odds in their favor. While some illness is obviously unavoidable, greater than 70 percent of the diseases that plague us are likely preventable. Indeed, teaching our young people what lies ahead if they fail to care for themselves may be the most valuable gift they can ever receive.
Ongoing, grade-appropriate body education could affect the trajectory of health care spending itself. Medical and public health professionals should advocate the development of bodyworks curricula that begin in elementary school and continue through high school. This coursework should go far deeper than traditional health courses. We all remember those classes: extraneous, vaguely embarrassing hours that were never a serious part of our school day.
It is too late for us, the older generation, to truly get to know our bodies, ourselves. But without buy-in from a new generation that wants to stay well and knows how to do it, we face continued expansion of our bloated health care system. Worse, there will be few forces to oppose an America which traffics in addictive foods, poorly regulated chemicals, toxins and pesticides, and other health hazards. We must understand our bodies in order to perceive that which threatens them.
The benefits of teaching our children to truly know and lovingly care for the biological miracle that holds each life are endless and profound. The consequences of remaining clueless are very real and, sadly, all too obvious.
Barbara Berkeley is an internal medicine physician and bariatrician who blogs at Refuse to Regain.
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