An Ounce of Prevention is worth $750 Billion of Cure
As a soon to graduate nurse practitioner who returned to school after many years in public health, I read the interview with Dr. Jauhar with great interest. I have not read the book yet so my comments are based upon his responses to the questions in the article.
First, I agree with him that the fee for service (FFS) model is largely responsible for escalating healthcare costs in the United States. FFS has created a medical intervention system, not a healthcare system. It has taught physicians to essentially game the system in order to make money. It has made multimillionaires of many specialists. Second, I propose that medical schools are in an unspoken collusion with the FFS model. There are minimal to no grants for medical students because schools assume that physicians will quickly recoup those costs by over-utilizing medical interventions on their patients. Medical schools drive students away from family practice and into specialties. So blaming the FFS model only partially identifies the culprits.
Second, Dr. Jauhar, a congestive heart failure specialist, is really a medical interventionist. When a person has hit the CHF phase, the heart is permanently damaged. For most of his patients it took a lifetime to get to this point. The best we can hope for is to administer interventions that may or may not provide some decent quality of life knowing that a person with CHF will not be fully healthy.
The sad truth is that almost all CHF can be prevented. Ahh, but no one wants to talk about prevention because it doesn't pay doctors. If cardiologists really want to make a difference, as a collective, they should be in every school, every church, every temple, every synagogue, every masjid in the country talking about prevention and talking about it often and then talking about it some more. But cardiologists are not in the business of prevention. That has been left to family physicians and nurse practitioners.
The other responsible parties are the patients themselves who believe that their lifestyle choices come with impunity. The body can only take so much abuse before it fails. Dr. Jauhar states, "I think that exercising the soft kind of paternalism—where you encourage, control, communicate with the patient—is preferable in some cases than putting the entire burden of decision making on a patient who is sick." Yes and no. Some of the responsibility does lie with the patient, because they must adhere to medication regimen and lifestyle changes that are necessary to prevent further decline. At the end of the day, unless someone is hospitalized and hooked up to an IV, physicians are not going to be standing over their patients’ shoulders making sure they take their medications. There is no magic pill, there is only hard work and patients must do it, not the physicians.
We must all take responsibility for why the US healthcare system is not about health. It is about interventions. Everyone has bought into this system: physicians, hospitals, private insurance, Medicare and Medicaid, medical schools, and patients.
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