Healthy Living and Wellness
From Sick Care to Health Care
Most of us go to the doctor's office when we are sick. In fact, I have written about our sick care system that needs to shift toward health and prevention. For example, your doctor's note about your visit begins with the Chief Complaint followed by the History of Present Illness. Clinicians have to document disease findings in the form of medical conditions and the more interventions we do the more we get paid. In fact, I would get reimbursed more to find a wart on your body to freeze off than I would to spend 30 minutes speaking with you about diet and exercise. This makes sense if most of us only suffer from acute conditions such as colds, flus, sprains and other infections. Although we have all experienced these mostly short lived and treatable illnesses, the vast majority of health care dollars and disease in our nation is chronic. In fact, 7 out of every 10 deaths and over 75% of health care costs every year are attributable to only 3 major chronic disease conditions: heart disease, diabetes and cancer.
Unlike acute disease, chronic disease doesn't happen quickly and is not easily resolved. You can't catch a heart attack like you catch a cold or the flu. Heart attacks are the end results of decades of chronic inflammation resulting in plaque formation limiting blood supply in our arteries to the point where our life is in danger. We literally have decades to intervene and prevent heart attacks. Yet we ignore these opportunities and only focus our efforts on what to do in these moments of distress.
Given the chronic diseases of our time, we need a paradigm shift toward a prevention focused model. Research is a critical part of this shift. In my role as Medical Director at the College of Health Solutions at Arizona State University, I provide medical oversight and serve as co-investigator for many research projects at the Healthy Lifestyles Research Center. Here we focus on finding solutions to our chronic disease epidemic by researching exercise, physical activity, nutrition, functional foods, complementary and alternative therapies, the microbiome and community health interventions. Some of our studies include the role of vinegar in reducing blood sugar or Tai Chi and Meditation to improve blood pressure and relieve stress or exercise to express genes to prevent cancer and heart disease.
In addition to research in prevention and healthy lifestyles, the paradigm shift will also require a change in how we educate future physicians and financial incentives to make prevention focused visits worthwhile. This will require practical changes as well as philosophical changes in our understanding of health as more than merely the absence of disease. To help further this important dialogue, I offer the following definition of health: "Health is more than the absence of disease, it is a dynamic state of fluctuating equilibrium in all aspects of the human condition encompassing spiritual, emotional, psychological, mental and physical dimensions of life." With this definition of health we can begin to address all aspects of life realizing that each one plays an important role in why we stay healthy and why we get sick.
This concept of imbalance as the root of disease is not new and has been present in many ancient healing traditions. Combining this more holistic approach with our conventional medical knowledge as well as the novel use of technology in new models of care can be a powerful way to shift the focus to prevention. In this way, medicine can be expanded to include both acute and chronic preventive approaches to care. We can have our Chief Complaints for those acute situations when we are sick but we can also see our physicians and health care providers when we want to learn How to Prevent Illness (HPI) as well.