Let’s Change the Culture of Medicine
A reboot of Low Carb Lung Doc and how I hope we will change the culture of medicine
Hello Friends! Today marks a decision to move forward with Low Carb Lung Doc, a blog through which I discuss the impacts of pillars of health on how we breathe. I started this Medium publication last year, but with several other priorities at work and with our nonprofit, I have not made the time to regularly engage. However that changes now. The topic of metabolic health is so overwhelmingly important, that I think it’s overdue for us to start talking about metabolic health and how we breathe.
I have been thinking a lot over the past few months about the culture of medicine, and in large part a culture I would like to change. Much of modern medicine is devoted to making the diagnosis and prescribing medical therapies, and while this is definitely important, it often stops there. Little or no time is devoted to strengthening the pillars of health that underlie treating disease. And this is what this Medium publication is about. Some of these articles will be super basic and about insulin resistance and metabolic health. Some of these articles will bring in interesting articles from the peer-reviewed medical literature pertaining to metabolic health in pulmonary disease. And some will be about more personal journeys from doctors, athletes, and more. It’s a place to bring thoughts to you about how we can improve our metabolic health, and thereby our overall health.
There are certain things we can do that have been shown to improve health and quality of life in people living with chronic lung disease, not instead of but in addition to medical therapy. Therapeutic exercise and lifestyle counseling (we call this pulmonary rehabilitation in our medical circles) is one therapy that has been shown to be of benefit in a wide range of lung diseases, from COPD and asthma to pulmonary hypertension and pulmonary fibrosis. The same can be said for improving quality of sleep and making sure we take in adequate nutrition as well as address a person’s mental health. In fact when a therapy is actually effective across a wide variety of lung diseases, I would argue it is more than a therapy, but actually becomes a pillar of health. And sometimes bolstering these pillars of health has an equal or greater direct impact on helping people feel better than the medicines we prescribe. To be clear this blog is not to eschew life-saving medical therapies. As a physician taking care of people living with pulmonary arterial hypertension, there are no alternative therapies that I can prescribe in the place of our life-saving medicines to help improve patients’ quality of life, exercise ability, and length of life. That said, engaging people in discussion about the pillars of health in addition to medical therapy, I believe, pays dividends that a strict pharmacotherapeutic mindset cannot do alone.
I believe that one of the fundamental issues we face is how we view healthcare. And this blog as well as my day-to-day efforts in my clinic and through our nonprofit, Team PHenomenal Hope, is an attempt to deconstruct this and create a more meaningful model. The most prevalent mindset that many take toward healthcare starts with who and how we consider as well people and who and how we consider as sick people is completely siloed. When you think of a “well person,” you think of someone who is usually young, fit, and their doctor visits are devoted to screening and prevention (check blood pressure, fasting glucose, mammogram, colonoscopy, etc). Their visits are devoted to making sure they don’t have disease. Sometimes they are devoted to sustaining wellness with lifestyle questions. When someone is labeled as a “sick” person with a “chronic illness,” often they fall into a different category, which is devoted to the treatment of the sickness. This is mostly medication-focused, and little time is left for the lifestyle questions and ways to embolden wellness. While some conspiracy-minded people may see this as physicians “in the pocket of big Pharma,” driven to prescribe medications over all else, I see it as a structural consequence of the modern healthcare system in which really good doctors work. Quite simply, if you only have 20 minutes for a new patient visit and 10 minutes for a follow up visit, and the person sitting in front of you has blood glucose levels in the 200s, you’re going to have to focus on the loudest signal in front of you first, and there is little time to reach the rest of the issues (like the ones truly driving the high blood sugars in the first place). It takes much longer to go into concepts of metabolic health, insulin resistance, and how nutritional choices — even if not the sole driver — may be contributing to someone not being able to breathe as well as they could otherwise. It takes time to explain the physiology of sleep apnea and why addressing it with wearing a mask improves heart function. It takes time discussing what is exercise and empowering people with a mindset that everyone is an athlete (if they choose to be), and what that means.
So we will delve into this in this Medium blog. We will discuss a new culture of medicine that does not see well patient and sick patient silos, but the fact that the spectrum of wellness and sickness exists within each human being, no matter the presence or absence of a disease, and how focusing on wellness-promoting behaviors in addition to medical treatments may take health to the next level. As a pulmonologist, my focus will largely center on breathing and lung health, but I’m eager to see where this all goes.
We have a couple of recent grand rounds to use as starting points, including where we initially discussed this model of the culture of medicine and our recent discussion on the role of metabolic health in cardiopulmonary disease, so I’ll bring these concepts forward in coming weeks.
Thank you in advance for reading and your interest in this topic. I’m looking forward to exploring all of this together.