A common question I frequently ask my patients is:  Are the people you’re trusting with your healthcare decisions really a ‘healthcare’ provider?  Seems like a pretty simple question, right?  The problem is that we’re living in a day and age where the lines between ‘healthcare’ and ‘disease management’ are terribly blurred.

For example, on my case history form, I have a section that asks:

What medications(s) are you currently taking?

Then, it asks about their vitamins and is followed by a question that asks:

How would you describe your overall health?     Excellent     Good     Fair     Poor

I’ve been in practice for nearly two decades and it still surprises me to see patients who may take a half dozen or more medications (and no vitamins btw) but describe their health as “Excellent.”  Why?  Because the commercials on TV tell them that if they want to be healthy, they have to take this or that medication.  Because the people that they trust tell them that if they don’t take the medication, they won’t stay healthy.  The problem with both scenarios is that medications are not vitamins.  Whether helping to marginalize your symptoms or not, they’re still toxic and have side effects.  Further, I propose that if you are taking medications, prescription or otherwise, to manage a chronic illness, you’re definitely not in “Excellent” health.  A healthy person doesn’t need medication.

Nowadays, advertising has sold you on the notion that medicine is health.  It’s not.  Medicine is disease management and disease management is not the same thing as healthcare.  Now, I’ll be clear.  Modern medicine is a marvel of crisis care and intervention saving countless lives every year.  But you have to understand that it really stinks for chronic illness.  That’s why so many chronic illnesses are on the rise like cancer, heart disease, and diabetes, despite miraculous advances in medicine and technology.  The interventions we turn to in these illnesses just aren’t helping us to become healthier.

So, how do you know the difference between the two?  Here are a few clues:

You develop some sort of symptom and go to your doctor.  Your doctor performs all the tests, as appropriate, to determine the nature of your issue.  If he/she then:

1. Gives you a pill (Disease Management). This is symptom control.  The pill does nothing to necessarily improve your health but it does at least manage your symptoms enough to make you comfortable and/or prevent you from becoming sicker or even dying.  That being said, all medications are toxic and have variability of side effects.  So, while you’re directly managing the symptoms of your disease, you may actually be compromising your general health in the long run.  So many meds are tough on your liver, kidneys, digestive system, heart, nervous system…etc.  Not only that, many medications breed dependency, meaning that if you take it long enough your own body chemistry may never recover.
2. Hooks you up to some sort of gadget or gizmo (Disease Management). I run a chiropractic office and we routinely use passive therapies like electrical muscle stimulation and ultrasound to help decrease a patient’s pain.  But this type of intervention is also not healthcare.  It’s pain control.  It’s disease management.  A TENS unit, on its own, does nothing to improve your general health.  It just temporarily covers up your symptoms.  The same can be said for back braces, orthotics, and even hot packs.
3. Tells you it’s “normal” for your age (Disease Management). Now, this is a total cop-out.  Not only is it false in too many cases, it steals a patients hope and gives them a crutch to justify their illness.  Your body is designed to be healthy.  It will fight with every fiber and molecule of your being to resist disease and stay alive.  So, at what point does “dis-ease” become normal?  Always be wary of anyone who tells you that.  In many cases, what it really means is:
   1. “I see this a lot but don’t have much experience with helping people with it.”
   2. “I don’t know what’s wrong with you. (Here’s an antidepressant.)”
   3. “I don’t know if a referral will help.”
   4. “I’m too busy to help you fix it.”
4. “Pops” your back when you’re in pain (Disease Management). As a chiropractor, this one also strikes particularly close to home and so many of my peers operate their offices this way:  “Just give me a call when you’re have problems again.”  Seriously?  I thought as chiropractic physicians, our mission was to educate and keep the patient healthy, not just pick up the pieces after everything falls apart.  We should not be mimicking a failing model of disease management and you should expect more from your chiropractor.
5. “Pops” your back when you’re doing well (Healthcare). Chiropractic care has been shown to help improve a patient’s health above and beyond just pain management.  The problem is that most patients who see a chiropractor for pain don’t maintain their alignment and functionality after the pain subsides.  How can you expect to be at maximum health when your pain levels are never truly stable?  You can’t have consistent health when your pain is in flux.  My experience has shown me that the patient gets the most health benefits from adjusting once they are out of pain.  And, ironically, it’s much easier to keep a person well than get them well.
6. Tries to help you make meaningful lifestyle changes (Healthcare). Maintaining and restoring health is not mystery.  It’s largely about the choices you make, good or bad.  Truthfully, most people know what they need to do to stay healthy, but they still fail.  Why?  Because becoming sick is easy.  Anyone can do it.  But not everyone will stay healthy.  Additionally, most people don’t have a support system and they’re turning to the wrong people for healthcare advice.  Too many people turn to a disease management provider for healthcare advice.  That’s like asking an electrician about why your sink is backed up.  Listen, I’ve said it before.  Maintaining optimum health is about 6 things: Proper Diet, Exercise, Stress Management, Proper Sleep Habits, Limiting Toxic Exposure, and Healthy Nervous System Function.  But, you may not know how to do those things well.  You need a healthcare provider.  You need a coach.

If all you’re getting from your doctor is a pill or procedure and you’re trying to get your health back, I hate to break it to you: you’re in the wrong office.  If, however, your provider is spending time with you to council you on better nutrition, help you with exercising better, and work with you to better your lifestyle, then you’re on the right track and in the right place.  Think about it.  Almost all of us have a disease management provider, but how many of us have a healthcare provider?  If you can find a good one, you may even surprise yourself at how healthy you can become.