Steven Charlap tells the story of the failure of his MDPrevent business which he had to close down last month. It’s an honest and thought provoking reflective piece. His idea was to have a medical practice which focused on health instead of disease, which advised patients and supported them in making lifestyle changes instead of prescribing for them. It didn’t work out. For a number of reasons……he didn’t get enough referrals from other health care providers, had many problems with health insurance companies, and, he says, the patients weren’t really up for it.
Based on our review of the credible research, our model mostly excluded dietary supplements and multivitamins because the science mostly did not support their use. When it came to pharmaceuticals, we didn’t rush to prescribe if there were a non-drug alternative. This approach was a turn-off to many patients who expected a prescription or emphatically clung to beliefs in supplements. And the no-cost, no-deductible, no co-payment provisions in Medicare’s preventive benefits may have had an adverse effect on people’s sense of its value. How much would you appreciate something that has no cost to you? For many patients, it seemed easier to take supplements than to be more attentive to food labels and exercise habits.
I have a lot of sympathy for this doctor. I think the present system of health care is not about health, and is not sustainable. I’m not so sure about the emphasis on prevention however…..let me explain – to prevent something has a negative tone for me, and I think health is a positive attribute. I prefer a focus on positively creating health, rather than negatively trying to prevent, or avoid disease.
His conclusion is particularly striking –
Patients loved my practice because I was willing to spend up to two full hours with them, most of it not reimbursed by insurance. The extra time often meant successfully making a diagnosis that had eluded other doctors for many years. It takes a very long time to get a thorough history and do a good exam and almost no time to prescribe a medication for a presumed illness. I chose the former. Insurance pays for the latter. Unfortunately, we still have a healthcare system that makes money by treating disease, rather than by preventing it.
and that last sentence is the real indictment in this story “we still have a healthcare system that makes money by treating disease, rather than by preventing it.”
What do you think? Do you think we need health care which helps people to create health? Would you like a service like that?
Heroes Not Zombies 
Eugene Boring, an American theologian, makes the following comment of a crowd in the Gospels: ‘They have all of the notes, and none of the music’. It feels like this with the NHS: ‘we have all of the notes – drugs are prescribed, boxes ticked, doctors are overwhelmed; but none of the music – health, well being. If health clinics are not feasible on a one-to-one basis, could not community clinics be offered with an emphasis on life style, nutrition, exercise, mindfulness, meditation?
Yes! !!! I would love to be part of a Healthcare set up that matched the ideas suggested by Bob and Bernard. Where and when did we go wrong with the current philosopy of healthcare?
In the distant past the wise Chinese medical authorities fined its practitioners if their patients did not maintain health but instead became ill.
What a shame, and my condolences go to SC and all the people he must have helped or would have helped – it’s really our loss – how disheartened he must be after being defeated while doing the right thing, strangled by the system. The age of enlightenment is worthless if our eyes are closed. We are not cookies and cookie-cutter solutions are no solution at all.
Physical health will always reflect what is or has happened on an emotional level. So, from that standpoint we cannot prevent falling out of balance – we can only look for ways how to get back to balance and maintain it by eliminating things that we have under “control” (food we eat, supplements, exercise etc.). I believe we need to convey the message to public that our health is about how we perceive what is happening to us in everyday life and how we manage our ups and downs. We need health care professionals who help people understand where their health is coming from and how much power is in their own hands, the responsibility for health needs to shift to patient.
Correction – I meant “managing” instead of “eliminating”