Priests and Layfolk

I can’t believe I am actually saying this, but it may be that the thing that I find unsettling about family medicine is the emphasis placed on patient centered care and preventative medicine. It’s not that I don’t believe in those things, I absolutely do. The only way we as a population can become healthier is by preventing ourselves from doing those things that make us unhealthy. And of course, the patient should always be at the center of health care.

The problem with preventative medicine in its current incarnation is that we have made basic common sense seem like something you need an MD to understand. Preventative medicine is not rocket science: don’t smoke, don’t drink too much, eat fresh stuff, exercise, don’t get too fat, don’t get too stressed. It is possible that by naming these topics medical we have actually done a disservice to our patients. Once something is medical, it is seen as inaccessible to anyone other than a health professional. Practitioners have become the priests required to access common sense; we are the intermediaries between laypeople and their own health.

Along those lines, with patient centered care, the patient is always right and every concern they have is equally valid and important. Of course a patient’s worries should be addressed, but I’m not sure it’s to their benefit to come in for every 2-second pain or unusual sensation they experience. This is linked to the sequestration of common sense to the medical elite. People don’t trust themselves anymore. They have no connection to their bodies and so they doubt every feeling they have. Normal body processes are now seen as death knells. The medical field reinforces this ignorance of self by giving a visit to every preoccupation. And we validate every anxiety by solving it with medical advice. Instead of saying. “well, sometimes that just happens,” we prescribe opiates or anti-anxiety medicine. And our latest trend response to non-issues issues? Yup, you guessed it. . preventative medicine, which means that people only do preventative medicine when they are told to as a curative measure (and is that really preventative anymore??). (And on a side note, of course there are forms of preventative care that should never be abandoned - cervical cancer screening, for example).

I'm not 100% sure if I agree what I wrote above. Since I believe in holistic medicine and I believe in treating the entire person rather than the illness, there is something to be said for being able to prescribe things like "eat better," and "exercise," and "meditation." And I never want the medical pendulum to swing back in the direction where doctors are patriarchal figures - telling their patients what is best without any input from the patients. That said, I do think that we these 2 concepts aren't sitting quite right. There is work to be done there, because I'm not sure that, at this point, we are doing the best by our patients.