Dr. Sara Gottfried: Access to health care is a fundamental right

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I’m sure few would disagree when I say that our current healthcare system is broken. The majority of healthcare spending is for lifestyle-related conditions – nearly 70%! There’s nothing “proactive” about that – it’s completely reactive.

One of the greatest flaws of our current medical crisis is that we don’t help people stay on the path of greater health; preventative care is not given the attention it deserves. This is also why I believe in universal health care, which means I favor a single-payer, government-run system. I believe access to health care is a fundamental right regardless of pre-existing conditions or ability to pay, and increasingly, a majority of Americans agree. Nearly every other developed economy has this model in place, and they provide better care at lower premiums than exist now in the United States.

Preventive medicine is not about low-value or no-value care, as are found in up to 42% of Medicare patients. Often times this is attributed to needless, unproven, or harmful tests such as CT or MRI for low back pain in patients that lack neurological signs, or arthroscopic surgery for chronic joint damage. This type of wasteful care accounts for 30% of healthcare spending. Instead, I love the idea of 4P medicine: preventive, predictive, personalized, and participatory.

Think about it – a small fraction of high-value care occurs in the clinician’s office. What happens when a patient goes home, heads to the grocery store or the gym, and makes daily decisions that add up to health (or a lack of health)? This is where we need to focus more. In my experience, many patients know what to do after a clinician appointment, but they need more help with sticking to it. They need more intimate and steady care by a team over time.

Ultimately, I believe we will need to use paraprofessionals (an individual who is assigned a particular aspect or is specialized in a professional task usually relating to patient care) more in the therapeutic encounter and for follow up.

Integrative/functional medicine is the ideal model for preventative medicine – it utilizes a collaborative clinician/patient relationship, high-value and evidence-based care, with attention paid especially to the how-to and how-to-keep-it-up after the time is up in the office.

However, that’s easier said than done. I’ve been taking care of patients for about 25 years and there are times when a patient’s other clinicians are not open to integrative and functional medicine. After years of medical school, residencies, continuing education, and then finally having your own medical practice, you want to have a little authority. You recommend smart things, hopefully change lives, and establish caring and long-term relationships.

Collaboration is the way to make integrative and functional medicine available to all. On an individual level, collaboration can be as simple as keeping an open mind and finding a common language with various healthcare practitioners along a spectrum from conventional to functional medicine.

As a clinician, I regularly reach out to other healthcare professionals taking care of a patient and/or send a referral note regarding their problem list and what I am planning (testing, protocols, follow up plan). I copy them on testing that I perform, and offer my contact information. It’s more than I was taught to do in conventional medicine as the standard of care, but it allows the patient to feel that his or her team is more integrated and informed about his or her care. I would never stop a medication or start a new one without touching base first with a prescribing doctor or primary care clinician.

The average appointment with a conventional doc is seven minutes – during which they are dispensing advice and rules – there’s often not much room for dialogue or partnership. I get it. I don’t take it personally. I was educated in the conventional paradigm and understand the distrust, and even dismissal, of anything unfamiliar, even when well proven and safe.

I sometimes provide my patients with etiquette scripts when it comes to charged or difficult conversations with their other healthcare providers.

Here are some scripts that I suggest as conversation starters.

“I just read a book about how to correct common hormone problems, and I learned a lot. I brought you a copy in case you are interested. I know we don’t have much time today, but I would like to discuss it at my next appointment, and what my problems might be. Would you be willing to discuss it next time?” (Note: This is how I first read Dr. Uzzi Reiss’s book, Natural Hormone Balance back in 2001. It works!)

“I’ve read a lot about hormones and am trying to make myself an educated consumer. I read in a particular book, by a doctor who specializes in hormones, that it’s important to look beyond some of the standard tests to really understand what’s going on. Because I’m experiencing [insert your symptoms], I wonder if you’d be willing to order a blood test for me.”

I’ve also defined for my patients the characteristics of a clinician who works collaboratively and is less likely to treat them paternalistically.

  • Is a keen listener. Not in a hurry to interject his or her own opinion.
  • Stays current with the literature. For example, ask if they are aware of the latest thyroid guidelines on what designates a normal level of thyroid function.
  • Understands nuance. Do they hear your symptoms, attune to your narrative, and then consider your labs? Non- collaborative doctors prefer to treat labs only.
  • Has a right-sized ego. Do they get defensive with your suggestions? Get a bit hot under the collar when you kindly notice they didn’t wash their hands in front of you at the beginning of the appointment?
  • Has time to address your concerns. Or is the hand on the doorknob when you work up the nerve to mention your libido or irritable mood?                                                                               

Author Note: Sara Gottfried, MD is a three-time New York Times bestselling author of The Hormone Cure, The Hormone Reset Diet, and her newest book, Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging, and Turn Back the Clock 10 Years. She practices functional medicine in Northern California. Visit SaraGottfriedMD.com for more information.

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