What if we’re wrong about focusing on providing Patients with “time with a Doctor”?

In this inspiring “What if we’re wrong about diabetes?” TedMed 2013 Talk, Dr Peter Attia discusses the urgent need for Healthcare Professionals to remove “the excess baggage of new idea resistance“:

…what if obesity is a coping mechanism for a far more sinister problem going on underneath the cell? I’m not suggesting obesity is benign but what if it might be the lesser of two metabolic evils… …consider the following analogy: think of the bruise you get on your shin when you inadvertently bang your leg into the coffee table. Sure the bruise hurts like hell and you most certainly don’t like the discoloured look but we all know the bruise per se is not the problem, in fact it’s the opposite – a healthy response to the trauma… …now imagine we thought bruises were the problem (and) we evolved a giant medical establishment and a culture around treating bruises: masking cremes, painkillers, you name it, all the while ignoring the fact that people are still banging their shins into coffee tables… …how much better would we be if we treated the cause…rather than the effect… …we can’t keep blaming our overweight and diabetic Patients like I did, most of them want to do the right thing but they have to know what that is and it’s got to work. I dream of a day when our Patients can shed their excess pounds and cure themselves from insulin resistance because as medical professionals we’d shed our excess mental baggage and cured oursleves of new idea resistance sufficiently to go bad to our original ideals: open mind, the courage to throw out yesterdays ideas when they don’t appear to be working and the understanding that scientific truth isn’t final but constantly evolving. Staying true to that path will be better for our Patients and better for science. If obesity is nothing more than a proxy for metabolic illness what good does it do for us to punish those with the proxy?

It’s abundantly clear that today’s medical establishments are loaded with cultures designed to treat the effect rather than the cause. There is no quick fix for this but we are slowly waking up to how the sick customs we have adopted as a society are failing Patients eg. soda brands sponsoring the Olympic games, Breast Cancer charities promoting themselves via “pink” alcoholic beers for the “Thirsty” or promotional pink paint jobs on deep fried fast food outlets.

I personally think the most fundamental misdirection of the medical establishment is the presumption that Patients want more “time” with Doctors. Government bureaucrats and NHS administrators in the UK are waging a war against hard working family Doctors as a result of their failure to appreciate this. Insisting that NHS Family Doctors open up their offices late into the night and weekend (to the extent that Dr Mark Porter, Chair of the BMA Council, is claiming that GPs are being left “bored silly” because patients aren’t then turning up) to serve the needs of Patients who are working full time seems like a good idea until you understand that Patients talk about having “time with a Doctor” as a proxy for “the attentions of a Doctor” and 99% of full time employees in the UK have a mobile phone on their person 24×7 through which their Doctor could provide them with documented consultations (like we do at 3G Doctor).

One of the reasons I feel Doctors fail to serve obese Patients is because the medical establishment’s customs and focus on providing “time with a Doctor” is alienating Patients from accessing preventative healthcare services. Obvious examples of this can be found when you consider a Patient who has noticed that their weight has started to increase (perhaps because they’ve got a Withings Mobile Connected BodyScale). In many instances a Patient like this could benefit from the attentions of a healthcare professional but in a culture where most GPs don’t believe that obesity is within their professional domain it’s not easy to go and book an appointment with someone who probably won’t welcome you to discuss something that might be nothing. In my experience convenient, anytime, anywhere access to personalised attention can make a step change here.

In Dr Peter Attia’s story imagine if he had been able to give that Patient needing a foot amputation his full attention rather than just his time? Perhaps instead of pulling back the curtain to find a Patient needing a foot amputation he could’ve glanced at a document on his iPad before he even approached the curtain and he could’ve taken a moment to feel exactly how bad this Patient was feeling about being there before him right now because they were obese as a result of a metabolic illness…

Imagine if that Patient had never encountered Dr Attia because the Patient was using a mobile connected weigh scale that was connected to their HealthVault PHR account that automatically sent them a clinically validated interactive medical history questionnaire that facilitated them having a metabolic illness picked up and treated by their family Doctor?

To learn more about how online tools are being used to provide Patients with the attention of a Doctor (rather than just their time) watch Prof John Bachman MD, Professor of Primary Care at the Mayo Clinic, introducing this Mayo Clinic Proceedings paper that explains the value of the Clinically Validated Interactive Patient History Taking Questionnaires that we use as part of the documented consultation we provide at 3G Doctor.

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