There are many ways to diagnose and treat a disease in medicine. A comprehensive approach informs you of all your potential options, and is essential to make good medical decisions.
A truly comprehensive approach goes beyond treating disease. It includes options to prevent disease, live longer, and live "optimally”, aka "wellness". Doctors that don’t provide this are disconnected from their patients needs.
Primary care fails to provide a comprehensive approach
Your primary care doctor is the person most suited to providing you with a comprehensive approach. She is a good communicator, knows you the best, and lacks the bias of the specialist. Yet, she often fails to do so. Particularly with respect to chronic medical conditions, optimal health, and longevity.
For instance, a patient with chronic insomnia is typically offered a prescription sleeping pill. However, there are several treatment options for insomnia that do not rely on pharmaceuticals . A partial list includes: supplements, meditation, exercise, sleep hygiene, stimulus control, sleep restriction, progressive muscle relaxation, and cognitive behavioral therapy. Some of these can be as effective as a sleeping pill.
There are also myriad options for optimal health; these include: hormones to stay youthful, supplements to boost memory, foods to prevent disease, etc. Yet, most primary care doctors fail to address these.
Why primary care fails to provide a comprehensive approach
1. Incomplete training - Doctors finish training with a significant knowledge gap. Although medical school is exceptional at teaching the pharmaceutical and surgical approaches to acute medical problems, it is notoriously weak teaching the management of chronic conditions, non-pharmaceutical options, and optimal health.
2. Just out of training - Due to incomplete training, a new inexperienced doctor is ill equipped to provide a comprehensive approach.
3. Obsolete knowledge - To provide a comprehensive approach one's knowledge must be current. However, with knowledge growing at an exponential rate, and a lack of time, it's almost impossible for most doctors to keep up.
4. Lack of counseling time - A comprehensive approach takes time to employ. Even simple problems have many solutions. These take time to communicate. The more solutions, the more difficult the decision making; another time consuming process. Finally, it takes time to implement the options (especially non-pharmacologic options). For example, it takes time to help set-up an exercise program, or teach meditation. The current fifteen-minute office visit does not allow for any of this - it's easier to prescribe a pill.
5. Inexperience with weak claims - Many of the options for chronic conditions, optimal health, and longevity, are weak claims with weak evidence. Some are pseudoscientific, and some fall outside the realm of science entirely. For example, most supplements have bypassed regulation and are poorly studied. How would one evaluate a supplement claim? Without reliable resources to perform reviews, sorting out the weak evidence requires time, experience, and critical thinking. It is not something stressed in medical school. Most doctors are uncomfortable, ill-equipped, and simply lack the time.
Patients are at risk for misinformation
Patients missing a comprehensive approach from their doctor can easily seek it out for themselves on the internet. Unfortunately, finding good information is very difficult. Health misinformation spreads faster and further than good information. We have all witnessed several recent misinformation crises, known as "infodemics". Without the skills necessary to distinguish good information from bad information, patients are very vulnerable to misinformation.
Concierge Medicine and a comprehensive approach
I realized very quickly that my patients wanted to be involved in their healthcare. They wanted to be informed of all their options including non-pharmaceutical approaches, living longer, and living optimally. Consequently, providing a comprehensive approach has become one of my prime directives. And throught the Concierge Medicine model, with its low patient volume, I’ve had the time and freedom to accomplish this.
1. Completion of training - I have had over three decades to complete the training not provided in medical school.
2. Continually updating knowledge - I have devoted myself to lifelong learning by applying case-based learning. Each case I see launches a thorough investigation to update my knowledge.
3. Ample counseling time - Concierge Medicine gives me time to review all of your options, help you decide which options are best for you, and implement the options that require instruction and follow-up
4. Experience with weak evidence - Learning how to evaluate weak or pseudoscientific claims is quite challenging indeed. I've had the chance to evaluate thousands of such claims over the last 30 years (see here, here, and here). My approach involves the application of critical to medicine; to read further, click here.
Providing you with a comprehensive approach equips you with accurate information for topics normally riddled with inaccurate information. And only with accurate information are you empowered to make the best decisions for your health.
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