Why is medical care in the United States twice as expensive yet half as effective as much of the developed world? There are many answers to that question but from my perspective three rise to the top:
1. Lack of whole person or functional care due to an over-reliance on specialization.
2. Doctors are poorly trained in nutrition, exercise prescription or promotion of behavior change.
3. We rely on and overuse medication for diseases that are brought on by lifestyle.
I’ll elaborate on these three issues but first a brief story. Toward the end of medical school, my advisor invited me into her office for a chat. She asked what specialty of medicine I was going into. When I told her it was Family Medicine she reacted with distress. “You are wasting your career. If I had my way the Family Practice program would be kicked out of the teaching hospital.” In her mind, medical knowledge was way too vast to incorporate into a general practice making specialty training mandatory. In one sense, she was right. If I need brain or heart surgery, I want a highly trained specialist to perform it. If my child has a rare or hard to treat infection, I will be very thankful for the knowledge of an infectious disease specialist. I’m grateful for my many friends and colleagues who have chosen to serve as specialists in various fields, and I constantly rely on their help as consultants. But there is another sense in which my well meaning advisor was completely wrong. More on Friday.