Thursday, October 23, 2008

Lifestyle and How to Get the Most from Physicians


I was talking with a friend the other night about the appropriate way to use physicians. He has been going to the same primary care physician for many years and seems to be weaning away from dependence on this doctor. Currently, I seek advice from two physicians, one internist and one family practitioner, over the internet. I have not met either in person, but have communicated mostly by email, and occasionally by phone.

My two physicians, John McDougall, M.D. and Joel Fuhrman, M.D., have provided me with excellent advice about nutrition, lifestyle and the appropriate use of the health system. They have also been excellent at advising me about some specific conditions.

Dr. McDougall has been especially helpful in providing me with guidance as to how to use the health system. His newsletters on the topics of How to choose a personal physician, Securing Respectful Medical Care, and Taking Advantage of the Medical Specialist are all excellent.

My use of the health system has been heavily influenced by Dr. McDougall. At the core of his and Dr. Fuhrman's philosophy is that we need to take charge of our own health and not depend on the health system to keep us healthy. We each have the power to determine our own lifestyle. Lifestyle is the principle component of health. Most of the diseases that cause premature death and disability, even those influenced by genetic makeup, are preventable by adopting a healthy lifestyle including an excellent diet, moderate regular exercise, good sleep habits, healthy relationships, maintaining a healthy weight, and managing stress. Those that take charge of their health can, to a large degree, opt out of the health system.

Getting back to the conversation with my friend, we compared notes on our diet and our health. He transitioned to a mostly plant based diet several months ago and lost 25 lbs. Since he is an avid runner, he is especially pleased with the positive impact his weight loss has had on his running. He told me that he no longer goes to the doctor regularly or obsesses about his health numbers. I mentioned to him that I had decided to forego the annual physical exam and also do not concern myself about cholesterol, triglycerides, PSA readings, etc. I am not at all interested in periodic blood and urine testing, let alone the ritual of getting my "heart numbers" checked. My reasoning is that I am doing the most effective things to protect my heart and my health through an excellent lifestyle. Even if it turned out that my cholesterol was slightly elevated, I wouldn't do anything different than I am now doing. Certainly I would not take statin drugs or blood pressure reducing medication. I have great confidence in the power of lifestyle to keep me healthy. My friend also has come to the conclusion that periodic testing can be avoided by adopting a healthy lifestyle. See Dr. McDougall's thoughts on the Annual Physical.

I know my strong feelings on avoiding the annual physical and periodic testing are controversial. One friend called me "irresponsible" for not doing the annual physical and the periodic PSA exam. My response is that if I am ever really sick, I will go to the doctor. Under those circumstances I will be a good health consumer and learn as much as I can about my condition. My doctor and I will decide on an appropriate course of treatment. I always make a habit of carefully selecting my physicians. I inform my doctor up front that I will not sue him. I will put it in writing, if he wishes. That, I think, liberates him to only order for me what is really needed and to not practice defensive medicine.

That is not to say that I never do early detection screening tests. I have become convinced that one Colonoscopy after the age of 55 is useful. I had that test when I was 61 or so. For the most part, my visits to the doctor, if they occur, will be prompted by an illness that I cannot cope with without medical intervention. I am hoping that never occurs, but if it does, off to the doctor I will go.

So for me, in summation, the appropriate use of the health system can be summed up as follows:

  • Western medicine is excellent at treating acute illness, but generally not effective at preventing illness, helping patients maintain a healthy lifestyle or extending life. Some early detection mass screening is useful, most is not. (See Overtreated: Why too Much Medicine Is Making Us Sicker and Poorer, Shannon Brownlee and Should I Be Tested for Cancer: Maybe Not and Here's Why, H. Gilbert Welch, M.D., M.P.H.)
  • Remaining healthy is 100% an individual responsibility. If we adopt a healthy lifestyle, we can, for the most part, stay away from doctors and hospitals. The economics of physician practice do not accommodate physicians coaching patients on lifestyle. Physicians neither have the economic incentives nor are they trained to do so. The business of medicine does not always work to our best advantage. Doctors are torn between generating income for their practices and doing what is right for their patients. The patient, unfortunately, does not always come first. It is best to stay away from the "business of medicine" unless you really need to be there.
  • The right primary care physician can be helpful if he/she is truly prevention-oriented( a rare breed). I do have a primary care physician. If fact, I have two with whom I periodically correspond, ask questions, etc. They are both Board Certified physicians who are strong advocates of nutritional medicine. Unfortunately, no such primary care physicians that I am aware of live near me, so I relate to these physicians long distance. I am prepared to hop on a plane and visit either in person, if need be.
  • Specialists should be selected very carefully. I have a Cardiologist who I visit periodically (every two or three years) to check out what so far is a benign periodic arrhythmia that I have had all my life. "Knock on Wood," the frequency of the arrhythmia seems to have decreased since I adopted a 100% high nutrition, low salt, plant based diet. Keeping my stress level in check, daily meditation, and regular aerobic exercise are also of great importance in keeping my heart rate normal. I worked hard to find a Cardiologist who does not overdo tests and prescription drugs.
  • Avoid physicians who do not listen. The doctor/patient relationship should be give and take. Physicians who practice only by rote community standards and who do not take the time to get to know patients and address patients individual needs are to be avoided.
  • Switch if you are not happy. I not only select doctors very carefully (no easy task) but am not afraid to make a change if I am unhappy.

This formula has served me well in recent years. Taking charge of my health and avoiding the health system, unless care is really needed, is very liberating and I highly recommend it.


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