I totally get what this guy is saying. Doctors just follow the algorithm. Someone with very impressive sounding credentials goes through the medical evidence and writes a guideline. Usually, it's a committee of like 20-50 experts, all buddies who work in the best academic medical centers. They write the "Bible" of how to treat a condition.
In years past, these were treated exactly as they should be: as guides or suggestions. But with the push for better outcomes and better quality measures, idiot administrators and bureaucrats at the HHS decided these would be used to write algorithms tied to whether you get paid or not. Fail to do what's on the guideline and they dock your reimbursement or you lose your year-end bonuses. Now, thanks to people who control the money but have no actual medical training themselves, the guidelines are now medical law (does this sound familiar?)
So, if you're a doctor with a patient with high blood pressure, you have to start them on whatever the AHA says they should be on or you risk having a chart auditor report you for having the audacity to use your clinical judgement. The docs may very well know that the solution to many of these "general health" ailments is what they call "lifestyle changes," but they have to offer you the guideline directed "best practice." So you get a pill instead of:
Eat a proper, calorically-balanced, nutritious diet
Sleep adequately: 8 hours/night or 2 cycles of restorative REM sleep
Reduce stress because cortisol drives metabolic disease long-term
Go out and see the sun for vitamin D, mental health, and other benefits.
This should be the core of every general physician's practice with what we call "maintenance medications" given as acute interventions to keep numbers and risk down while you learn to stop living unhealthily. Of course, the devil's in the details and if you ask people, they don't actually stick to the lifestyle. The fast food's too convenient. They like the beer and cigarettes. Overeating at restaurants all the time is convenient and may be a socially encouraged activity. Exercise hurts. Sleep is often sacrificed for productivity. Constant stress is seen as unavoidable, and stress reduction is sacrificed for productivity, and when we live as office moles slaving for the Man, we don't get to go out and see the sun unless you put it as a background on your work computer screen.
So, you get the pills instead.
Just like education, health is something no one else can give you. You have to make an active effort yourself. Experts are guides, but you have to do the work.
I totally get what this guy is saying. Doctors just follow the algorithm. Someone with very impressive sounding credentials goes through the medical evidence and writes a guideline. Usually, it's a committee of like 20-50 experts, all buddies who work in the best academic medical centers. They write the "Bible" of how to treat a condition.
In years past, these were treated exactly as they should be: as guides or suggestions. But with the push for better outcomes and better quality measures, idiot administrators and bureaucrats at the HHS decided these would be used to write algorithms tied to whether you get paid or not. Fail to do what's on the guideline and they dock your reimbursement or you lose your year-end bonuses. Now, thanks to people who control the money but have no actual medical training themselves, the guidelines are now medical law (does this sound familiar?)
So, if you're a doctor with a patient with high blood pressure, you have to start them on whatever the AHA says they should be on or you risk having a chart auditor report you for having the audacity to use your clinical judgement. The docs may very well know that the solution to many of these "general health" ailments is what they call "lifestyle changes," but they have to offer you the guideline directed "best practice." So you get a pill instead of:
This should be the core of every general physician's practice with what we call "maintenance medications" given as acute interventions to keep numbers and risk down while you learn to stop living unhealthily. Of course, the devil's in the details and if you ask people, they don't actually stick to the lifestyle. The fast food's too convenient. They like the beer and cigarettes. Overeating at restaurants all the time is convenient and may be a socially encouraged activity. Exercise hurts. Sleep is often sacrificed for productivity. Constant stress is seen as unavoidable, and stress reduction is sacrificed for productivity, and when we live as office moles slaving for the Man, we don't get to go out and see the sun unless you put it as a background on your work computer screen.
So, you get the pills instead.
Just like education, health is something no one else can give you. You have to make an active effort yourself. Experts are guides, but you have to do the work.