Erosion. Not the usual topic for a GP to discuss, but when it comes to the conventional doctor patient relationship, it is the best word to describe what is happening. This erosion is not the fault of the doctors or the patients but is due to five main interrelated areas. In this article I’ll briefly address each of these and discuss potential solutions.
- The increasing epidemic of chronic disease.
- The ‘ambulance at the bottom of the cliff’ approach of conventional medicine in ‘managing’ this tide of chronic disease, which stems back to archaic medical school training that has not significantly changed as human science has changed.
- The lack of time doctors are able to spend with patients (mostly due to the first two factors).
- The ageing NZ population.
- The overwhelmed, ageing and therefore retiring GP population.
- This element is multi–factorial, but all are a form of ‘stress’ to the body, including nutritional stress from high calorie, nutritionally poor processed food for example; and environmental stressors such as pollution and medication over-prescribing. All these stressors are creating more and more complex patients that require multiple visits or longer consults. There are many possible solutions which are beyond the scope of this article, but as an example we need to seriously look at all environmental stressors, including the proposed new 5G network. More than 230 scientists from 41 countries have expressed their “serious concerns” about 5G with effects including “increased cancer risk, cellular stress, increase in harmful free radicals, genetic damage, structural and functional changes of the reproductive system, learning and memory deficits, and neurological disorders”.
- In 2016 the government updated the New Zealand Health Strategy and highlighted the need for ‘a shift from treatment to prevention’. Despite this there has been no significant progress, leading to increased demand for ‘ambulance at the bottom of the cliff’ type medicine as conventional medicine fails to significantly stop patients ‘falling off the cliff in the first place’. Whilst conventional medicine generally has the time for and is also able to assess and manage risk factors, for example high blood pressure as a risk factor for heart disease, it does not have the luxury of time or knowledge to look for and treat all the risk factors of the risk factors. This requires untangling of patients’ biochemical pathways, searching for and managing all possible underlying causes as a whole rather than treating patients as isolated body parts, an outdated reductionist style of medicine. Treatment protocols must be adapted to account for the new sciences of epigenetics and nutrigenomics (in simple terms-how our environment and nutrition ‘turns on or turns off’ our disease genes).
Potential solutions include government funding of clinics designated for investigating and managing all the root causes of chronic and complex medical cases. This would also require specialist training of doctors through bodies such as the Australasian College of Nutritional and Environmental Medicine. This would free up doctors in routine GP clinics to manage more straightforward cases such as is often the case with young families. Wider measures, such as unravelling the privatisation of profits, e.g. in the food industry and socialisation of costs, e.g.in the healthcare industry, will also significantly help.
- As mentioned above the first two factors contribute significantly to the lack of time doctors have with their patients. Added to this is the fact that over a third of GPs state they don’t have enough time to finish all their daily tasks, making it is easy to see why lack of time with patients is so prevalent. In addition, doctors are required to ensure they meet targets, e.g. for vaccinating patients. This compliance ‘war’ is time-consuming with every doctor consulting hour requiring 20-30 minutes of administration and paperwork time. Doctors do not go to medical school to learn to do paperwork but to help patients and every minute of paperwork erodes the rapport between them and their patients. Again there are many possible solutions, but one is more realistic funding of these compliance programs and measures to improve doctors work-life balance.
- Back in 2009 the government was aware that “ageing of the population alone, if nothing else changes, will “require” between 40 and 70% more health workers if current standards of care and of access to care are to be maintained over the next 10 or so years”. The solution here is a simple supply and demand formula. Reduce demand with the measures in areas 1. and 2. above and increase supply by addressing the doctor and allied health practitioner shortage.
- With more than 25% of GPs planning on retiring in the next five years , about half of NZ doctors experiencing burnout, and the government scrapping plans for a rural medical school late 2018, the issue is going to deteriorate if nothing is done.
The retiring GP population and co-existing lack of locum doctors results in more and more GP’s feeling the need to retire or amalgamate into corporate health ‘supercentres’. These centres further exacerbate the problem of patients seeing a different doctor each time. The solutions here, again, would be to make the speciality more attractive with better work-life balance and reimbursement. Adopting allied healthcare practitioners such as physician assistants, nurse practitioners and prescribing pharmacists would also assist.
These five elements affect young families the most because they, as a whole family unit, are unlikely to all see the same doctor. The relevance of other family members health at the time a patient presents to their doctor is unfortunately underestimated.
I can’t reiterate enough that the cost savings of adopting a Preventative/Integrative Medicine model would run into the millions, if not billions of dollars and increase the likelihood of patients seeing the same doctor and for longer leading to better health outcomes. It will take a mass movement, to upend the archaic ‘old boys’ conventional medical training model and establishment. Thankfully this movement is on the horizon, driven by patients desire for more than just a ‘pill for every ill’ and also by more enlightened health practitioners.