A Prescription for the Eventually Sick Masses

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Back in med school, I’d hear classmates comment, “Cardiology is the specialty of the future. All these unhealthy, obese people are going to have heart attacks.” I think the remarks were largely motivated by a desire for job security, clinical relevancy, and money. They saw the masses as the “eventually sick.”

Rather than consider the role the medical profession could play in altering the population’s health trajectory, we were trained to treat illnesses after they presented themselves. After making a diagnosis, we’d rely on prescriptions, procedures or surgeries to try to “fix” the disease.

Don’t get me wrong. If I’m in the throes of a live acute episode of a heart attack, I want the most up-to-date cardiologist and/or cardiovascular surgeon with the latest technology and medications. But if I’m seeking the care, guidance and support needed to minimize the possibility of having a heart attack in the first place, the medical system is not my best option.

Cardiac electrophysiologist and Medscape columnist, Dr. John Mandrola recently wrote, “The prescription pad is easy. The EP lab is easy. The truth is hard.”

Some have, in jest, taken this logic a step further saying, in effect, “Let’s just add aspirin, a beta-blocker and statin into our public drinking water and call it done.”  Now, the list of additives would include metformin to address the ever increasing prevalence of Type 2 diabetes mellitus.

There is growing evidence that medications alone carry risk as well as having a limited impact at the population level. We need them for established diseases, but we shouldn’t depend on them as the primary mode of treatment.

Concepts such as primary care/behavioral health integration, value-based care, patient-centered medical homes and health homes are models of care that move the boundaries beyond appointment-based, disease-focused models. There’s also an economic incentive to deal with the root causes of lifestyle-related cardiovascular diseases, because those approaches address problems before they become enormously costly and life-devastating.

It’s time to get beyond the medical office and address the environment in which people live and work. Let’s work to understand the consumer, their circumstances and what motivates them. Let’s examine behavior choices and consider the barriers to improved lifestyles. Clinicians, let’s start by figuring out our roles, working with others who have the skill sets to address psychosocial determinants, and address the needs in homes, workplaces and our communities.