“You cannot see the forest for the trees.”
-Attributed to J. Heywood in 1546
Our healthcare delivery system is complicated. In many ways, it has as many intricacies as the very system it seeks to serve; that is, the human body. Take any organ of the body and you will find volumes of material down to the microscopic detail. In attempting to simplify complexity, our minds have a tendency to break things down into component parts. As a result, we have our current system. The more we search, the more we find. In our pursuit, we develop specialists to address each of the new frontiers of detail. A person is no longer a person but rather a heart attack, a left hemiplegic from a stroke, a schizophrenic, an arthritic left knee, a lung mass, a diabetic, or even a k ras wild type colon cancer. But what if the layers can be attributed, in a large part, to an individual’s attempt to manage his or her health? After all, isn’t there a physician in all of us? Who doesn’t treat personal ailments with a family remedy or an over the counter medication? I wonder about something deeper, though. If the end result is death for all of us, what actually are we treating? Could it be as basic as the avoidance of pain? Could it be as complicated as managing externally imposed expectations? Could it be as profound as the age-old existential dilemma, “Why am I here?” Given the various ailments, it is only logical that there are various options for treatment. What we choose as our treatment plan may point to the question we are trying to answer.
Our healthcare system places our various body parts into silos. It starts with the very first question of virtually any interaction with a healthcare provider. At the point of contact, a patient is asked, “What is wrong?” A person begins to think about individual body parts and explains his or her symptoms accordingly. Furthermore, the person feels “broken” as the question begets the implication, “What is wrong…with you?” Have I not placed the patient in a rather vulnerable predicament? Another common question asks, “What treatments have you tried?” Again, the patient generally describes various over the counter medications for headache, abdominal pain, a rash, or bowel issues. Sadly, as physicians, we further exacerbate the issue by prescribing more medication for each of the symptoms. Not surprisingly, a person’s medication list grows along with the complications associated with multiple drug interactions. What if we took more time to ask people about behavioral choices related to childhood trauma? I am wondering how our system would look if we attended more closely to each person’s individual treatment plan.
According to the Center for Disease Control (CDC), our country spends 3 trillion dollars a year on healthcare (I am not exactly sure I even understand that number). As our minds are apt to do, I broke the 3 trillion down to some of the component parts and learned something rather interesting. About 700 billion dollars of the costs relate to three common self-treatment plans; food, alcohol and tobacco. The effects of obesity, alcohol abuse, and routine tobacco use account for nearly 25% of our total healthcare expenditures. How well do we address those issues in our society? Do we see those issues as weaknesses or logical choices for our life circumstances? If one considers various other self-treatment plans including recreational drug use, social isolation, and violence, just to name a few, one begins to understand the societal impact of our behavioral choices. There again, though, are we missing the bigger picture? Is it really about understanding each person’s individual treatment plan or would it make more sense to look at the common themes creating our search for a customized treatment plan? Our treatment plans are learned behaviors. We adapt to traumatic life events in the best way we can. Unfortunately, many of those choices have adverse consequences on our health. If we, as a society, took a step back and asked about common traumatic life events, would we not find a better way to manage many of our healthcare expenditures? If we are spending 700 billion dollars a year on the effects of food, alcohol, and tobacco alone in relation to treatment of trauma, do we not already understand the potential financial implications? What would it cost to raise awareness as we seek to develop trauma-free communities? More importantly, what will it continue to cost if we don’t?