Wednesday, August 15, 2007

No One's Going to Save Us

An anonymous poster left a comment about chiropractic this morning, which everyone who wants a little more insight than I can provide on the practice should read in its entirety (click on "comments" after my "Chiro-Skeptic" post below). He wrote about my chiropractor's recent diagnosis that I have forward head syndrome and the chances that chiropractic treatment will successfully fix the problem. One of his points was particularly striking:

...arguably most important is patient compliance. Given the DC has correctly identified what is going on, provides adequate physical medicine, manual manipulation and a correct exercise prescription - chances for success are decent. Chances are much better with patient compliance. There are 168 hours in a week, if you see a DC 3 times a week, 30 min each time, there are still 166.5 hours of time away from the office that the patient is responsible for and thus patient compliance is monumental.

This got me thinking about my own work as a fitness trainer, and about the health care industry in general. Now I'm not a doctor, nor am I a chiropractor. I don't even play one on TV (though I did, once, briefly, many years ago... but that's another story). But people do come to see me regularly for guidance on how to improve their health, and so I do share some of the frustrations of the professionals in that industry, even if I don't share in their six-figure annual income (of course, I didn't share in ten years of schooling, sleeplessness, and crushing debt either).

It's common practice to slam the American health care industry, and with good reason: it's an overpriced, elitist, labyrinthine mess (I haven't seen Michael Moore's latest, pretty much because I live it: as a lifelong asthmatic and a self-employed adult, I'm quite familiar with the nightmare of trying to get good service at a reasonable cost). I harbor just the slightest glimmer of hope that perhaps our next administration will be less concerned with busying giddy minds with foreign quarrels and perhaps a little more attentive to pressing problems at home. But for now, we have to face the fact that American health care is the mess that it is, and you and I have got to figure out a way to work with it.

What I'm making a plea for here is patient accountability. Yes, the system has made it very difficult for many health-care providers to operate at the top of their game, and we patients suffer for it. Yes, there are diseases and conditions that are simply not anyone's fault, and for which the only solution is long-term medication and care.

But let's be honest: there are also a lot of medical conditions -- a whole lot -- that are the result of our own poor choices. Back pain, which, depending on who you ask, is either the number one or number two complaint of the average E.R. visitor, is usually due to some combination of bad posture, a sedentary lifestyle, poor exercise habits, and a bad diet. One could say the same of headaches, of dental problems, diabetes, and even, let's be frank, many, many more severe digestive and cardiorespiratory conditions.

My wife has a friend she's known since high school who has consumed two liters of Pepsi every day of her life for as long as Heidi as known her. She suffers from a host of medical problems: bad teeth, poor body composition, reproductive troubles, digestive problems, bad skin. For long periods she has been so ill that she's barely been able to leave her apartment, much less work a steady job. Now I'm not saying there's a direct causal link, between the two-liter-a-day habit and the host of health problems. But I certainly think that better lifestyle choices could very well have staved off many of her problems and helped her heal more quickly from the rest.

Certainly, it's a doctor's charge to deal with whoever and whatever darkens their office door. And it seems to me that most medical professionals have that down pretty well: they take a history, note the symptoms, they prescribe the standard operating procedure. But if we the patients don't step up and start taking some serious steps to take better care of ourselves -- to eat better, sleep more, exercise harder and more frequently, find ways to take it easy outside our pressure-cooker careers -- how indeed can our hospitals succeed in being much more than a triage unit, desperately slapping Band-Aid treatments on one patient problem after another? Nine times out of ten, the problems that a patient faces go deeper: they're a function of something underlying, some behavior or other that has probably gone on for decades, and needs to change fast.

My chiropractor told me that 95% of physical problems are asymptomatic. A symptom surfaces only when the body's own coping mechanisms can't handle the stresses you're throwing at them, and runs a red flag up the mainmast in the form of pain or sickness to signal you to slow down or just stop hammering away at the body while it figures out a way to heal itself. I don't know if that's an accurate statistic -- I imagine it would be a pretty hard measurement to take -- but it's worth considering that a lot of the time, without knowing it, we may well be functioning at far below optimal levels.

Here's something I know to be true. Say you have asthma, as I do. Your bronchial tubes can be up to 50% blocked before you'll even register that you're having difficulty breathing. So maybe you'll pet the neighbor's cat politely, have a sudden, violent allergic reaction, and wind up in the E.R. When you get home, maybe you'll insist that your neighbor to have their cat euthanized, but in reality your asthma episode was not really kitty's fault, but rather the cumulative result of stress, pollens, pollution, poor diet, limited exercise and whatever other irritants your life requires you to confront on a daily basis. Once you're in the hospital, it's in many ways too late.

I recently saw a simple little diagram that I quite like: it's a continuum showing gradations of health, with "SICKNESS" on the extreme left side, "HEALTH" in the middle, and "FITNESS" on the extreme right. The suggestion is that fitness, practiced correctly, is an extreme form of health. It's as far away from sickness as you can get. So by living a healthy lifestyle we're not only staving off sickness but keeping our insides healthy in ways that are only detectable with the aid of centrifuges and microscopes. We might not feel it, but our bodies will thank us for it anyway.

I do think this is where medicine is headed: towards greater emphasis on prevention and lifestyle and less emphasis on treatment alone.

As one of the doomed passengers on the hijacked airplane says in Paul Greengrass' terrific film UNITED 93, "No one's going to save us. We've got to do this ourselves."

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