I think you are right, but I also think that the drive to become healthy has to be a partnership between the patient and the doctor. A doctor can't keep a person healthy who refuses to do anything for himself. One example: there has been a meteoric rise in esophageal cancer in the last ten years. Why? It is because of the epidemic of obesity, which leads to greatly increased numbers of people with reflux disease. Attributable to obesity, no other cause required. Over time, all that acid splashing where it's not designed to go leads to changes in the cells at the bottom of the esophagus (Barrett's esophagus) which becomes adenocarcinoma in a great number of people, given time. We've now reached the time when the years of damage are paying off as cancer in many many people
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70 percent of the weight you are is attributable to genetics. Seventy percent. And any acid reflux I have (yes, I'm fat) is probably rooted in the occasional bouts of reflux I had when I was still a skinny kid or the asthma inhaler (and yes, the asthma started before I gained weight too) I use, which weakens the esophogeal flap
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First of all, a disclaimer. I am 190 pounds, 50 years old, and had fat parents. I am not skinny and will never be so. The last think I want to sound like is one of those annoying 20-year old size zero twits who say things like, "Just lose the weight" when they've never had to and have no idea what it's like to try. If it came off that way, I apologize
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One of the things about this country's health care that I find irritating is the vast focus on weight control, as if it were the only thing that can be changed, and as if a person's health were predicated solely on that. It's a very convenient way of putting most, if not all, of the blame on the patient, which is of course very good for the insurance-based system. If the cultural view is that fat is the patient's fault, and we manage to connect pretty much all bad health with weight, then presto! The insurance companies can deny all kinds of things because they're caused by the patient's negligence, and not by anything THEY say they're responsible for. Nope, it's too easy
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I watched Michael Moore's "Sicko" the other day. One of the segments was on a British GP, who contrary to popular belief, was well-paid, had a lovely home and drove an expensive car. They are paid more if their patients stop smoking and control their weight, blood pressure, etc
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What is 70% genetics is a person's potential weight gain. In other words, my genetic pattern determines that I can get up to, say, 250 pounds, while someone else's won't let her get up to more than 170. Whether we do or not is based on a large array of factors, only one of which is the patient's attitude towards weight. Stress, lack of sleep, boredom, anxiety, happiness (or lack of it), income - all these contribute, some of them more than a person' attitude. I think you can tell I consider the weight thing as we see it in America as a boondoggle, a way for unscrupulous people to make a killing on the insecurities of a populace that is kept uneducated and in the dark about the health care system
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Also, yes about the GP doing well. The 80's were a huge blow to the idea that one can live a nice, reasonable lifestyle; in that decade, life suddenly became about being RICH, as opposed to being comfortable, and that's what drove so many students away from GP practice. Our family doctor had a very nice house in Santa Monica, one of the best areas in L.A., and lived a comfortable life, and he was only a GP. But all that became not enough somehow, and going into general medicine to make a nice, secure living became passe.
But if the universal system we're all hoping for is based on a solid foundation of GP practitioners, whose training would be far more broadly based in all the different aspects that make basic health, then that kind of medicine would become attractive again. Also, after a few years of economic difficulties, a nice, comfortable, reasonable living might well gain popularity again. You never know.
And this is a reason not to try? Nothing changes without a beginning to change, and this is a big one, in my opinion. The force of a good doctor's word, a doctor who knows you and not just your chart, can be a major impetus to taking care of oneself. By reviving the GP profession, we create a whole population of doctors with GP concerns, concerns that have to do with the regular health of the populace. Not with things like catastrophic disease and acute conditions, which have plenty of advocates already, but with things like basic nutrition, job conditions that impact health, etc.
The health care industry will not change, no - by itself. That's why the government must step in, and why we must have universal health care. Like I said, it was stupid to allow insurance to get involved in the first place; money never cares about anything but money. The point is to slowly shift health care away from being an industry and make it back into into something that's about helping, rather than getting rich. And we won't get there by
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I'm afraid that insurance companies are still too powerful and they've had WAY too much say over the health system for far too long. AND it's not just that. There are too many people in the US who have some gut response to the idea of government having any kind of interference in the health system. They scream, "OMG I WON'T GET TO CHOOSE MY DOCTOR111!" But the fact of the matter is, our system does NOT work except for the very wealthy. Even people with great health insurance have problems with the system. I don't have health insurance (except for my overseas insurance that MIGHT cover catastrophic issues), so I don't go to the doctor. I won't go to the doctor unless I'm dying. It's a totally inefficient system and one that absolutely needs to be overhauled.
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But if the universal system we're all hoping for is based on a solid foundation of GP practitioners, whose training would be far more broadly based in all the different aspects that make basic health, then that kind of medicine would become attractive again. Also, after a few years of economic difficulties, a nice, comfortable, reasonable living might well gain popularity again. You never know.
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The health care industry will not change, no - by itself. That's why the government must step in, and why we must have universal health care. Like I said, it was stupid to allow insurance to get involved in the first place; money never cares about anything but money. The point is to slowly shift health care away from being an industry and make it back into into something that's about helping, rather than getting rich. And we won't get there by ( ... )
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