As doctors, we have pills to treat infections and high cholesterol. We have scalpels to replace hips and open clogged arteries. But beyond pills and scalpels, what tools do we have? Walking out of the doctor’s office without a prescription is a rare occurrence these days. And the famous surgeon tagline has always been “a chance to cut is a chance to cure.” We see people when they’re sick and we’re trained and expected to do something. But do we want more than one of every five kids and nine of ten older Americans taking prescription drugs? Do we really think that more heart stents are the secret to longevity? Of course they are if we believe our job as physicians is to treat the symptoms rather than the cause.
I’m trained in Preventive Medicine, one of the twenty four specialties recognized by the American Board of Medical Specialties. Out of the nearly 16,000 medical students that graduate every year, only about 120 choose Preventive Medicine. Does that really mean that less than one percent of doctors think preventing disease is more important than treating it? I’m afraid so. Maybe it’s because our medical culture hasn’t figured out how to profit off health, rather than sickness? Or maybe it’s because our doctors simply aren’t creative enough to think beyond pills and scalpels? Of course it’s a mixture of both and many more, but I think the main reason is we’re absolutely clueless how to treat bad lifestyle from the confines of the 8 minute office visit. It’s a horribly outdated tool for the problem at hand.
Health happens in your home and in your neighborhood, not in the exam room. Health is all the little routines you have in your life, some of them good and some of them bad. But in order to lead a wonderfully fulfilling life, we have to look at health as being the optimal mix of good food; fun movement; real relationships with people you love; financial success; a job that leverages your best skills; a neighborhood that makes health easy; and the wild card— sex, drugs, and rock & roll. I threw that last one in because health has traditionally been so burdensome and black and white. But in real life, health is grey and life is fun. And being a good doctor is much more than writing prescriptions and doing procedures, it’s about knowing your patients and inspiring them.
My first practice was strictly a house call practice where I’d see patients in their apartments here in Brooklyn and follow up with them via email or Skype. It was lean and cost $1500 to launch. I was profitable in the first month because my overhead was only about 10%. My patients paid me via PayPal and my visits were typically less than $100. I couldn’t have done any of this without my iPhone and my MacBook. I used today’s technology to practice yesteryear’s medicine. It enabled me to be real-time traveling somewhere in my neighborhood awaiting my iPhone to alert me of my next appointment. Granted, I couldn’t see 40 patients a day like other doctors. But I wanted quality, not quantity. I wanted a real relationship with good, respectful communication. And 6 to 8 house calls a day in your neighborhood gives you way more information about people than 40 harried visits in some faraway institution. But that’s just the business side of things.
Most importantly, I saw how people lived. I could see the chubby person’s potato chips on the counter, the mice droppings in the asthmatic’s ultra-cool Williamsburg loft, or the depressed person’s evidence they spent a lot of lonely time by themselves staring at glowing rectangles. My neighbors were my patients and I couldn’t walk more than two blocks without someone saying “Hey Doc!” I liked to think that every time someone said that, they were reminded about living healthier. They saw me at the farmer’s market on Saturdays, going to the gym, having barbecues in the backyard with friends, and drinking at the corner bar. I became a regular fixture in their neighborhood. Hopefully, I was this occasional little familiar nudge that inspired them to chase the good life. And if you ask me, that’s what we as doctors need to be asking ourselves the next time we write a prescription— am I inspiring or am I perpetuating a broken system?