Apart from the potential to save billions of dollars, preventative health care provides the opportunity to enable affordable health care and a better quality of life right across society. But how would preventative health function as the primary form of health care? And what would preventative health care look like on a scale that resembles the current interventionist system? But where do we even start? We do need to a clear picture of preventative health care as a total system if we are going to move in that direction, but we also need to describe a credible place to begin.
I have been deeply encouraged by the warm response to my earlier posts questioning the current interventionist, industrialised, profit driven health care system. Most significantly there has been a good response from professionals within the health industry, demonstrating a growing awareness of the problems the current system faces, and an openness to have a conversation about it.
An awareness of the problems does not necessarily describe the solution. We all have our own ideas about what may be done, and as individuals we may feel that it is impossible that our individual actions could make a difference. However, from my experience I think it is possible for individual professionals of various disciplines to demonstrate effective models that may show the way.
I didn’t set out to challenge or change the current health care system. Preventative health care is something that I stumbled into and the model I created was purely the product of trying to get my clients (and myself) the best possible outcomes. At the age of fifty two I became a personal trainer in my own quest for great health. That meant that I attracted a lot of older clients and they, like myself, came with evolving health or function issues (or both). This meant I needed to engage my clients with allied health professionals, as their issues were either above my pay grade, or it was simply more efficient to engage other disciplines. This lead to me, quite unintentionally, being at the middle point in their health care, coordinating their process.
I took care of their exercise program, focusing on improving function and metabolism, and helping them with their diet. However they would inevitably need postural correction and so I would refer them to the osteopath, or joint issues, so the physiotherapist – and then there was the massage therapist, and over time it became more involved, including other practitioners within the medical fraternity (GP’s, cardiologists etc.) although generally indirectly – through the client – because, unfortunately, personal trainers aren’t taken that seriously (and that’s a topic in itself).
The key issue was that my clients’ process was not something they could manage themselves. It was too confounding for someone who is typically confused about health to start with. Simply, they didn’t know who they should consult or when, or even if they had an issue. This meant that they did not have the strategy necessary for a successful outcome. For example, I had a new client who needed a knee replacement due to a football injury thirty years previously, but wasn’t eligible (too young).
We started on exercises to stabilise his knee, and improve his activation patterns and proprioception, and rehabilitate the wasted muscle in his affected leg. As strength returned with the hypertrophy of muscle and improved neural function, I referred him to my osteopath because his pelvis was way out of alignment due to the long-standing muscle imbalances associated with his injured knee. The osteopath realigned his pelvis, which resolved his scoliosis and took a great deal of pressure off his spine. We continued with his program and at appropriate times I would refer him back to the osteopath and also a massage therapist. To cut a long story short, 12 months after we started he was on a skiing holiday and knee surgery is no longer a consideration.
The point of this story is a universal one – it often takes multiple disciplines to either fix or prevent illness and injury. More significantly, it requires a good strategy to coordinate these disciplines to get the desired outcome. In the example I just described, it was necessary for my client to improve his strength before he saw the osteopath or the alignment would have failed within days. The massage therapist was necessary to relieve the muscle imbalance, but that would not have worked if he wasn’t also doing exercise. But it was also equally important that he saw these practitioners at the right time in his rehabilitation ‘journey’.
I know this is not strictly a story of preventative health, but for arguments sake, let’s imagine that he had engaged in the process I described right at the beginning. The years of compromised function aside, he spent many years and many thousands of dollars trying to get his knee sorted, visiting a multitude of specialists – this one then that one – the cost of which was subsidised by the health care system, which was costing everyone.
I have more stories like this but the results changed with the specialist field that was required. While my physiotherapist and osteopath (in Australia osteopathy is a 5 year degree while a GP degree is 4 years) were happy to talk to me and coordinate the care, I couldn’t get a cardiologist on board – they just wouldn’t talk to a personal trainer. This is unfortunate because a good personal trainer has the exercise data which will describe a great deal about a person’s health – especially cardiovascular health. The only way around this was for me to prime the conversation my client would have with their existing specialist to get feedback. While exercise is a great way to achieve health, it is also very revealing of what is not okay, and this led to some clients getting a quite important diagnosis.
So how is it that I was playing in the same yard as very highly educated specialists? The bottom line was that there was no one else who was playing the role I found myself in. And this reveals fundamental flaws in the current system – your GP has not studied exercise or nutrition, the dietician has not studied exercise, and highly qualified specialists know a great deal about their subject but generally not much about other specialist fields. So who is there to coordinate a person’s particular needs with a sound strategy?
This makes me wonder if we have not become “over specialised”. It seems that people are falling down the cracks between the specialist fields. So I have continued to play the role I now call ‘collaborative health coach’. I think this is a model which can describe, in part, how thepreventative health system may work. It requires an education in exercise and nutrition and a general knowledge of what all other disciplines offer and how they can contribute, and most importantly a good personal working relationship with a professional in a range of disciplines. The ‘coach’ can then help to create a strategy for the client, based on feedback or instruction from the various disciplines as required. I believe this is a safe and effective option because the coach is not pretending to be a GP or specialist, but is referring clients through to the people who can help – and those specialists can feedback with instruction or take over the care if necessary. Keep in mind the emphasis is preventative health care. No doubt a GP would be in a better position to coordinate patients already with chronic disease.
This idea also makes it easier for medical specialists. I’ve had many ‘indirect’ conversations with doctors and specialists who are seeing significant improvements in their patient’s wellbeing as a result of exercise and good nutrition – blood pressure returning to normal, and reduction of medications from beta-blockers to cholesterol or diabetes medications. I think any cardiologist recommends exercise to their patients – but they also need someone they can refer their patient to, that they can also trust to get the job done effectively, and that they feel comfortable with.
The bottom line is this, we have a massive amount of science and very highly qualified specialists with amazing treatment options, but what is lacking is the conversation between the specialists, between the people who can help, and the coordination and strategy that leads to the desired health outcomes. I think it doesn’t matter which field you are in, you need a team. Working in isolation only creates a void around that specialist field.
At the moment it is a case of seeing a physiotherapist and if that doesn’t work see an osteopath, and if that doesn’t work see…. you get the idea. It just doesn’t work.And it doesn’t work not just in the preventative health care sense, but it doesn’t work for interventionist health care either.
What I imagine for the future of preventative health is an ‘ecosystem’ of diverse disciplines or specialists working within a team of allied professionals to enable an individual’s long term care. What I have found is that trusted and established relationships are vital. I know all my allied health professionals personally, I also see them for my own issues, and they are all happy to further my education in their field and how they can help. I can provide them with data about the clients training history and abilities. Most importantly we are working with clients as issues appear rather than waiting for that issue to become a problem that ‘takes over’ and imposes limitations in other areas of the clients life.
And why would a personal trainer (who may also be university qualified) or ‘collaborative health coach’ be in the mix? Because a person’s ability to exercise is an incredible measure of their current state of health and function. Exercise is extremely revealing, and equally it has a profound ability to prevent and heal disease. But it seems very few personal trainers understand how much data they have and how much they could help their clients by engaging other disciplines. Typically their business model is based on ‘owning’ their client. This is a reflection of the current embedded conflict of interest that exists right throughout the health industry.
Do we need to know more than we currently do about human health? That will always be the case, but the real issue is whether we are effectively using the science and technology that we are already have. Do we need more skills? Definitely, particularly along the lines of cooperation – along with a near universal change in attitude towards health care. The health care system cannot bear the cost of the arrogance that can possess people of position and influence and prevents cooperation.
Will industry ‘roll over’ or change direction? Given that interventionist health care is so profitable, and the intransigent and questionable behaviour demonstrated by, for example, the pharmaceutical and food industries, I expect that would be a resounding ‘no’.
Will the government agencies help? Well, when I stop laughing at that idea I’ll let you know. So where do we start to implement change? Victor Hugo famously said that there is nothing more powerful than an idea that has found it’s time. I have a feeling in my bones that the idea of preventative health is finding it’s time, even if it is primarily because we can see that the future of the interventionist system is unsustainable. The existing ideas are failing in front of our eyes with the decline in overall human health, even as science and technology improves.
What we need is to grow the consensus of opinion of professionals within the health industry – to create the conversation that empowers the idea of preventative health that then changes the status quo. Will it be easy? Not a chance. But the mechanisms for change are more available than ever – this is the Information Age which enables ideas to become increasingly powerful. This does have the potential to overwhelm vested interest and intransigent governments and impotent bureaucrats eventually. So perhaps the first question I should have posed is ‘what can I do, right now, to contribute to a future of preventative, efficient and effective health care?’ Start a conversation with friends or colleagues? Connect with other disciplines and start to build your own team? Any small step will start the process of evolution toward a fair, just and sustainable health care system.
I would absolutely love to hear your ideas, and for a loud, clear, articulate conversation to be heard that engages the enlightened professionals who can make a difference.