My doctor said….
A pharmacist’s reflections on real conversations and statements by customers in the pharmacy
I want to start by saying this is not intended to be critical of doctors, nurse practitioners, physician’s assistants, or any other general practitioner in the traditional healthcare system. This is meant to shed light on the hot mess that is our healthcare system which includes acute care, pharmacy settings, family medicine, and the multitude of specific disease care settings that continue to keep people confused and disempowered about their health and their ability to be an advocate for their own wellness.
Most healthcare heroes are incredibly intelligent, hard-working individuals who didn’t go to school for years and come out in debt from a long arduous process of becoming a healthcare provider because they were in it for the money or the fame. They became doctors or nurse practitioners with the intention of helping people. But if they work in a traditional healthcare setting, then they, and even me, are just small cogs in a huge machine that is the American healthcare system, or disease care system as I like to call it. I don’t want to be a cog in this wheel any longer. I am working to find a better way through functional medicine and exercise science. That is why I am only part-time in the pharmacy. But some days even a few hours in the chaos that is the retail pharmacy, I struggle internally with what I truly believe is the right course of action versus the route that customers believe and were told is the only way, which is more meds and more meds.
The following are the top 3 most common statements said to me over the last 15 years. They also stand out the most because people truly believe that they have no choice. Our current medical system doesn’t help people get well and stay well and it disempowers them to make choices that actually affect their health.
“My doctor said I just need to take this pill.”
This might just be my favorite. This usually starts with a question at the register. The technician says, “Do you have any questions about the medication.” The customer replies, yes, and they are sent to consultation. When I approach I usually ask, “what questions do you have about the medication,” and the answer 9 times out of 10 is, “my doctor said I just need to take this pill.” My reply is, “So you aren’t sure why you need this medication.” Some people say yes, but most say no or they aren’t totally sure. It never ceases to amaze me the number of people that truly have no idea what a medication is for even when they come straight from an appointment.
It’s mindboggling how someone can walk into a medical establishment, discuss their health with a provider, and come out knowing no more than they did going into the appointment. Or is it? How long were they actually in the appointment? What was really said by the healthcare professional while they were there? Did they review labs? Did they teach the patient anything? Maybe they did or maybe not. Maybe there just isn’t enough time to discuss the myriad of health problems that the average American struggles with each day.
The average appointment with the physician, which doesn’t count the nurse taking vital signs, is around 18 minutes. Many primary care offices use brief appointment slots which can lead to appointment overrun, increased wait time for patients, and overburdening providers. Longer appointments are critical for complex patients, however, most of these patients are only allowed up to 30 minutes for their appointments. Researchers have found that during these short appointments, a very limited amount of time was dedicated to specific topics, 6 being the average number of topics discussed. Only about 5 minutes were spent on the longest topic and the remaining topics received 1.1 minutes each. Even when more topics were introduced during the visit, the length of the visit overall varied very little. Is it any wonder that patients come out knowing very little if any information on the status of their health and disease management?
The appointment length could very well be the main problem with a patient’s confusion. Researchers and government officials seem to really like to blame appointment time because it fits into a neat and tidy measurable basket. It’s easier to blame the primary care offices for just not managing their appointment slots well enough to provide appropriate care for complex patients. I don’t discount time as one of the main reasons why people don’t understand the nature of their disease, however, to me time is secondary to the real root cause, disease miseducation.
By disease miseducation I mean the belief that a disease is mostly out of our control and that the only course of action is continued use of a medication. Not only does the average American believe that medication use is inevidatble but too many health care professionals believe it too. Before I discovered functional medicine, I even believed it.
Why are doctors only taught to diagnose and prescribe rather than promote health and wellness through quality sleep, quality food and the right dose of exercise for a unique individual? Could it be that medical school and pharmacy school curriculum lag behind new scientific information like the recent epigenetic discoveries or if we follow the money trail would we discover that scientific research is backed by Big Pharma and therefore Big Pharma has a hand in the standard of care that is considered appropriate for certain disease-care therapies.
Healthcare in the US is big business. The pharmaceutical industry is big business. Expenditures for healthcare (although we should call it disease care), research, and other items and services have increased tenfold since 1980 and now costs the nation more than $2.6 trillion annually. This is the largest figure per capita in the industrialized world. That is alot of money funding a system that doesn’t really seem to be helping people get well.
But despite all the money pouring into this broken system, the US is behind other nations in health indicators. So the US spends more money on healthcare, but the quality of care is lower than in other high-spending countries like Norway and Switzerland. Makes you wonder exactly why we keep funding this broken system. Where is the funding for health education and nutrition in school? Wouldn’t it be way cheaper to teach adults and children how to leave healthy lifestyles rather than prescribe them expensive medications that slow disease progression, not result in disease reversal?
There are so many aspects of our current system that are a waste of resources, money, and ultimately people’s time. They would get more benefit from hiring a personal trainer or wellness coach and learning how to create health rather than go to appointment after appointment in which nothing truly changes and their health continues to decline.
“My doctor said diabetes must just run in the family. We all get it and it’s because of our genetics.”
How disempowering is that statement? To truly believe that you have no control over your health outcome because of your genes. In many ways, our society is still living by the Darwinian dogma that our genes determine our destiny. But there is another hypothesis that was disregarded by scientists but is now finally making its way back into mainstream research because of recent advancements in genome science, the epigenetic theory.
Jean-Baptiste Lamarck presented his theory of evolution 50 years prior to Darwin. His less harsh theory suggests that evolution was based on an “instructive, cooperative interaction among organisms and their environment that enables life forms to survive and evolve in a dynamic world.” (Biology of Belief, Bruce Lipton). His theory was that organisms can pass on adaptions necessary for their survival in a changing environment. The key word here is changing. Unfortunately, Lamarck was ridiculed and his experiments were forgotten once Darwin came on the scene with his theories of evolution, in which we have no control over our genetics and changes in gene expressions are just random and “lucky” genetic accidents. Lamarck’s theory implies that mutation in genes arises from the need to adapt to life-threatening environmental stresses, so they are not random and can be changed and predicted! I hope as the field of epigenetics expands and research continues, our understanding of diseases and the risk of getting certain diseases will finally make its way into medical school textbooks and be taught as the foundation of healthcare rather than an afterthought.
How different would a doctor's appointment be if patients were taught that they have the power to live disease free by controlling the environment in which they live? If we could teach patients that they are in control of their genetic expression instead of their genes controlling them, our disease-care system could turn into a real healthcare system where maintaining health with foundation lifestyle choices like eating real food, exercising, and decreasing stress is taught at each appointment.
“My doctor said my lab work was fine. They are just going to monitor my blood sugar.”
Everything is fine. I guess my question is why do you want to be “just fine” when you can be great? Why is “fine” considered a goal when it comes to your health and wellness? And what constitutes fine when it comes to basic labwork anyway? Take blood sugar levels for instance. Why are patients told that the doctor will just monitor their blood sugar levels? What is this monitoring that happens? Are the practitioners taking random samples each day, week, or month? Are they tracking with a continuous blood sugar monitor? Sadly, I think not. Instead, they are just waiting for a level above the threshold for diabetes, and then they can prescribe medication.
If you really think about this scenario it seems rather ridiculous. So keep doing what you are doing for another 6 months to a year and then once you have a higher reading based on labwork, then you will get a drug to lower blood sugar. Why is this acceptable? Why are patients leaving the doctor's office without being told to change what they are eating, decrease stress and move more? All of which would decrease blood sugar levels without a drug!
When it comes to labwork, education is critical for the patient to understand that just fine means it could be better, and just fine is really the average in a country where the average isn’t so great. Labwork is only one small part of the overall health or disease of a patient and it is only a single point in time, not the end all be all. In a real health-promoting medical paradigm, labwork would be used to motivate patients to change, not used to validate the use of medication.
Choosing drugs over food
More than three in four adults in the United States think the costs of prescription drugs are unaffordable and nearly one in three adults say they haven’t taken their medications as prescribed due to costs. In 2019, the U.S. spent more than $1,000 per person on prescribed medicines, an amount higher than any other nation. In 2019, the U.S. spent $1,126 per capita on prescribed medicines, while comparable countries spent $552 on average. This includes spending from insurers and out-of-pocket costs from patients for prescription drugs filled at the pharmacy. Patients are literally choosing to buy drugs over quality food. How many elderly people can’t buy fresh fruit and vegetables because they are “put” on 2 or 3 expensive medications per month?
The prices of many brand-name drugs used to treat conditions including diabetes, cystic fibrosis, and cardiovascular disease are more expensive in the U.S. than in Germany, the Netherlands, Switzerland, or the U.K. For instance, the price of Humira in the U.S. is 423% more expensive that the price in the U.K. and 186% more than that in Germany.
The cost of medications is increasing as more brand-name drugs come to market. The sad fact remains that these drugs are all treating diseases that can be changed by changing lifestyles. Only 3% of diseases are truly due to genetic defects that are outside the control of a person. When looking at this system, one that disempowers, bankrupts a person and the government, and continues to keep a nation sick and fat, I am amazed that more people are not outraged and standing up for change.
I do understand that some of what people say may not have been what the doctor really said and some people are raised with a belief that the doctor knows more about their body than they do. I would like to change that. I would like for us to raise our children to believe they are the experts on their bodies. After all, they live in their body day in and day out. I would like us to teach people that preventative care in the traditional setting really isn’t preventing anything, it’s early detection. I would like yearly visits to be focused on a client/coach model instead diagnosis/prescribe-a-pill model. If we teach people from an early age foundational lifestyle habits for health, then they will have the knowledge and perhaps the will to create health their entire lives, rather than the belief that they are not in control of their health destiny.