Wednesday, April 15, 2009


For many years, I collected reports from patients disappointed in the medical care they received. For several years patients would come into my office and complain that they had seen several doctors, had many investigations and tried many drugs without benefit. I noted that patients routinely left the care of their physicians and shopped around the “alternative” community and bought curious, bizarre and often expensive tests, treatments and products with little hope of benefit.

I am aware of the limitations of physicians, however, and want my well-educated, well-motivated reader to recognize these limitations and assume responsibility for their own management. When you look critically at modern medicine you see expensive techniques deployed to rescue individuals from calamities which were often avoidable. Although many talk about the "health-care system", they are really talking about a high-cost medical intervention system, directed at treating diseases that are fully developed, but not preventing disease. While “high tech” medicine promises miraculous cures, there only is a short list of problems which can be fixed by medical or surgical methods but a much longer list of problems which cannot be fixed.

One problem is that MDs seldom learn how to manage food-related diseases. In the physician’s mind, food is someone else’s responsibility. Physicians, like everyone else, have prejudices and preconceptions that limit their understanding of the complex issues that determine food selection, metabolism and the consequences of bad diets. Both physicians and patients have an overwhelming bias in favor of drug and surgical treatments. Medical practice is based on a routine of ordering tests and writing prescriptions for drugs.

While diet and “life-style” modifications are mentioned in medical texts, few MDs pursue this approach to patient management. Many MDs have argued that the task of changing patients’ habits is beyond their mandate, is too time-consuming, and is often futile. Even if MDs are interested in solving food-related problems, they are usually too rushed to spend the time necessary teach patients the knowledge and skills they require to self-manage effectively.

There is a fundamental misunderstanding between doctors who know something about their limitations and patients who often have unrealistic expectations for fast solutions. Both sides of the relationship become frustrated and tend to act irrationally when quick and easy solutions do not work. The more passive and dependent a patient is, the deeper this misunderstanding grows and the more expensive it becomes. Patients demand more investigations, referrals, and support services. Physicians tend to order more tests and prescribe more drugs and that are increasingly potent and more risky. When neither strategy works, many illnesses remain unsolved, suffering is not relieved and expensive problems continue to drain the resource of individuals and their communities. Stephen Gislason MD

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