Reclaiming “Medical” Care

Once again, we have people shifting words around to mean whatever they want them to mean, even (especially?) when a word itself means little or nothing. Today I am discussing the word “health”, specifically in the context of the phrase “health care”.

What, precisely, is “health”? The simplest definition would be “the absence of disease”. You can toss in the word “wellness” in the same context, with the connotation of well-being, in the sense of “not sick”.

According to a recent New York Times Op-ed about overdiagnosis as a flaw (hat tip to Dr. Bob), the idea that you need a doctor to confirm that you are indeed “not sick” is a relatively new development:

It was [Richard] Nixon who said, “we need to work out a system that includes a greater emphasis on preventive care.” Preventive care was central to his administration’s promotion of health maintenance organizations and the war on cancer. But because the promotion of genuine health — largely dependent upon a healthy diet, exercise and not smoking — did not fit well in the biomedical culture, preventive care was transformed into a high-tech search for early disease.

So that’s when it started!

In the past, doctors made diagnoses and initiated therapy only in patients who were experiencing problems. Of course, we still do that today. But increasingly we also operate under the early diagnosis precept: seeking diagnosis and initiating therapy in people who are not experiencing problems. That’s a huge change in approach, from one that focused on the sick to one that focuses on the well.

I agree. In fact, beyond a very short list of conditions (blood pressure screening for atherosclerosis; pap/HPV screening for cervical dysplasia; some kind of screening for colon cancer, be it universal colonoscopy or some kind of fecal test; and a surprisingly few others) in which early diagnosis has proven to extend life, I would argue as a physician that you should NOT be consulting with me unless you felt something was wrong with you.

In discussing problems with coordination of care, Dr. Stephen Schimpff writes (via KevinMD):

We don’t have a health-care system; we have a medical-care system, one that was developed to care for patients with acute problems…

I agree with this statement. However I disagree with Dr. Schimfpp (and lots of other people) that this is a bad thing. I am a medical doctor. I have been trained to provide MEDICAL care. What exactly is “Health Care” anyway? As noted above, “health” is indeed “largely dependent upon a healthy diet, exercise and not smoking”, therefore I submit that fostering these things is more in the purview of Public Health, as opposed to the private medical care of individual patients.

Think about it: doesn’t everyone know that poor diet, lack of exercise, and smoking are bad for one’s health? If not, shouldn’t they? Shouldn’t it be a matter of public policy to see to it that this basic information is promulgated to the general public? Hey, it was Surgeon General Luther Terry in 1964 who first warned the American people about the dangers of smoking. Eating a healthy diet requires things like access to fresh food, which is more a commercial issue than a medical one. Regular exercise — mainly walking — is more a function of city and regional planning, addressing sprawl and the over-dependence on cars than of anything I’ve been trained to do.

I don’t provide “health care” because there is no such thing, and I hereby reject the term “Health Care Provider” in order to semantically reclaim the terms that are rightfully mine and my medical colleagues’: Doctor of Medicine, Family Physician, and Healer.