It used to be that being a doctor was just about the most rewarding thing you could do with your life. When diseases were commonplace and surgery was akin to a miracle, the only thing between you and permanently shuffling off this mortal coil was a god-like character in a white coat.
Doctors doing something made a difference. Surgeons were gods and if you died you would have died anyway. And nobody sued you because you can’t argue with gods!
Well, things have changed and the fee-for-service system rules, OK? Many would argue that the system is unfairly funded and doesn’t provide the best possible healthcare. It certainly doesn’t reward people for doing what makes the most difference – keeping people well.
The reality in general practice is that few patients present with a clearly defined condition needing ‘medical’ management. In fact, many present with the physical symptoms of stress and anxiety or minor ailments. For most patients we see, we offer platitudes and reassurance but little of real value because we’re not trained to manage patients who don’t have a clear diagnosis.
We tell the patients to come back if they feel worse or when they ‘qualify’ for something more seriously ‘medical’.
Many patients vote with their feet and try their luck with alternative practitioners. Maybe 40 minutes of Myofascial Release Therapy for a ‘cervicogenic’ headache is better value than a $90 10-minute consult with a GP and a script for an NSAID with the added bonus of gastritis.
It’s little wonder we start to question both our role and future relevance as we struggle with the dissonance between our training and what we are actually doing.
What do we do with all these ‘well’ people or the ‘stressed’ whose myriad symptoms don’t fit into the box of a treatable medical condition?
Is it time for a new paradigm, a different type of health system? Why not go back to first principles and look at the causes of current major health conditions? There’s now overwhelming acceptance of the link between stress, lifestyle and diet with the major causes of morbidity and mortality.
It’s now time for doctors and the health system to become the custodians of diseases and wellness using a model that addresses the real causes. And instead of lamenting the disappearance of pneumonia, let’s help our patients attain what the ancient Greeks called Eudaimonia – a life worth living, both physically and mentally.
Just imagine, doctors being equitably rewarded for providing quality, evidenced-based medicine and having time to do their job properly. How wonderful it would be to become an integral part of a system that genuinely manages wellness from ‘cradle to grave’.
We could call it LET – Life Enhancement Therapy. Now that’s what I would call preventative medicine!