Where are you? Where do you want to be? How do you get there?

Man studying street mapWhat do I mean by this?  It is my goal for a new health care system that can be summarized by:

  • 1st – Diagnose the cause
  • 2nd – Define your health goals
  • 3rd – Begin treatment

Where are you? – Diagnosing the state of the patient.  When I use the term ‘diagnosis’, I intend a couple of concepts that may not be included in many people’s definitions.

1) Deep – I intend diagnosis to have depth, to include understanding root causes.  Diagnosing ‘diabetes’ or ‘high blood pressure’ is a nice start, but it is a very superficial diagnosis.  I am referring to a deep diagnosis that includes understanding why a patient has those conditions.  Is the diabetes due to insulin insufficiency, insulin release timing or insulin resistance? Is the issue related to essential nutrient deficiencies (zinc, chromium, magnesium, etc.)?  The research data regarding causes of disease is far more advanced than many people realize.  Deep diagnosis includes looking beyond the superficial diagnosis and understanding causes.

2) Broad – I also intend diagnosis to be broad as well as deep.  To cover all the human dimensions: body, mind, spirit, social and environmental.  Many patients and doctors are now actively looking for root causes of health conditions, but what if the root cause is not in the physical?  How many patients with physical ailments have psychological, social, environmental or even spiritual factors as root causes?  How many people with psychological issues have physical causes?  I have seen this over and over again.

As an example, think of the patient you might know who is obsessed with their sickness.  They talk frequently not about getting well or having great vitality, but instead, obsessing on how horrible they feel.  They are looking to get their needs answered by being ill. In this example.  This type of patient is frequently resistant to implementing what might be relatively simple lifestyle changes that could cure their condition. Until diagnosis encompases a wider range of possible causes, we are limiting our chances of successful outcomes. It is time to broaden our diagnostic vision.

Where do you want to be? – Personal goals.  Why is it important to spend time discussing personal health goals as part of the new health care system?  The assumption is that everybody wants to be pain free and functioning at maximum effectiveness, but is that always the case?   What if maintaining the current: diet, lifestyle, family relationships, living environment, etc. has a higher priority in the patient’s mind?

A common example here is regarding weight loss.  Many patients come in saying they wish to lose weight, but on closer questioning, they have factors supporting the idea of maintaining their excess weight.  They may be uncomfortable with the attention they receive when slim, they might not want to change their lifestyle, they might be trying to punish a spouse or like how they feel with the added weight, etc. etc.  What will the patient be doing consciously or unconsciously to sabotage their success when their stated goal is at odds with other unarticulated desires?

When there are multiple goals, it is necessary to identify them, prioritize them and resolve any conflicts.  This will enable efficient efforts by all people involved in the health care recovery program and improve outcomes.

How do you get there? – Treatment.  In this area of the new health care paradigme, I also intend a couple of things that may not be included in the common definitions.

1) Sequence – Diagnose the cause first, then start treatment. (in non-emergency situations).  This may seem obvious.  Why would you want to jump from the frying pan into the fire?  But think of this…how many times have you known patients, friends and therapists start recommending treatments without first finding out what the patient really needs or what they want to achieve?  Think of how many times you have seen somebody start taking ritalin for ADHD without first looking at serotonin or tryptophan levels, allergies, toxic buildups or omega 3 fatty acid status?  How many times have you heard somebody say something like “Try this food, It worked wonders for me”.

2) Personalized care – We live in a time where standards and protocols define the rules for how people should be diagnosed and treated.  This model of health care contains a certain degree of assumption that everybody has the same causes for each condition.  We know this is not a valid model in some areas of health so why should we apply this same approach so broadly?

For example, with fevers,, we know these can be because of infection, injury, sunburn, exertion, toxic reaction or medication side effect just to name a few.  Nobody would think of applying antibiotics to someone who had just run a race.  Why do we treat everybody who has high blood pressure essentially the same?  In a review of the literature, there are at least 100 different causes of high blood pressure.  Treating everybody with the same methods will likely obtain poor results for obtaining a cure 99% of the time.

Summary   Overall, there is too much emphasis placed on what to do, and not enough on what is needed or what is desired. I would like to suggest that more attention be given to a deep and broad understanding of  what the patient’s current status is and clarifying goals before recommending any treatment.

When traveling, we wouldn’t do any of the following and expect a successful journey:

  • We’re beginning our trip from someplace in North America (Are you N, S E or W of your destination?)
  • We want to arrive over there… someplace…. (How about 123 Main Street, Anytown, NY for a specific address to travel towards?)
  • Everybody go north by north east! (No matter where you are starting from or where you are trying to go)

‘If you don’t really care where you end up, then it doesn’t really matter which way you go.’  Adapted from Alice in Wonderland

It’s time to plan our health care journey with the same  level of detail and systematic approach we use when planning our other types of traveling.

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