Erosion. Not the usual topic for a GP to discuss, but when it comes to the conventional doctor-patient relationship, it is the best word to describe what’s happening.
This erosion is not the fault of the doctors or the patients but is due to five main interrelated areas:
- The increasing epidemic of chronic disease.
- The ‘ambulance at the bottom of the cliff’ approach of conventional medicine in ‘managing’ this tide of chronic disease, which stems back to archaic medical school training that has not significantly changed as human science has changed.
- The lack of time doctors are able to spend with patients (mostly due to the first two factors).
- The ageing New Zealand population.
- The overwhelmed, ageing and therefore retiring GP population.
1. This element is multifactorial, but all are forms of stress to the body, including nutritional stress from high-calorie, nutritionally poor processed food, for example, and environmental stressors such as pollution and medication over-prescribing. These stressors are creating more and more complex issues, meaning patients require multiple visits or longer consults.
One environmental stressor that needs urgent review is the proposed new 5G cellular mobile network. More than 230 scientists from 41 countries have expressed their “serious concerns” about 5G, citing radical effects including increases in “cancer risk, cellular stress, harmful free radicals, genetic damage, structural and functional changes of the reproductive system, learning and memory deficits, and neurological disorders”.
2. In 2016 the government updated the New Zealand Health Strategy and highlighted the need for “a shift from treatment to prevention”. There has been no significant progress, however, leading to increased demand for ‘ambulance at the bottom of the cliff’-type medicine as conventional medicine fails to stop patients falling off the cliff in the first place.
Whilst conventional medicine is generally able to assess and manage risk factors – for example, high blood pressure – as a risk factor for heart disease, it does not have the luxury of time or knowledge to look for and treat all the risks of the risk factors. This requires untangling patients’ biochemical pathways and searching for and managing all possible underlying causes as a whole, rather than treating patients as isolated body parts: an outdated reductionist style of medicine. Treatment protocols must be adapted to account for the new sciences of epigenetics and nutrigenomics (in simple terms, how our environment and nutrition “turns on or turns off” our disease genes).
Potential solutions include government funding of clinics designated for investigating and managing all the root causes of chronic and complex medical cases. This would also require specialist training of doctors through bodies such as the Australasian College of Nutritional and Environmental Medicine. This would free up doctors in routine GP clinics to manage more straightforward cases, such as is often the case with young families. Wider measures, such as unravelling the privatisation of profits, e.g. in the food industry, and socialisation of costs, e.g.in the healthcare industry, would also help significantly.
3. As mentioned, the first two factors contribute significantly to the lack of time doctors have with their patients. Added to this is the fact that over a third of GPs state they don’t have enough time to finish all their daily tasks, making it is easy to see why lack of time with patients is so prevalent. In addition, doctors are required to ensure they meet targets, e.g. for vaccinating patients.
This compliance ‘war’ is time-consuming, with every doctor’s consulting hour requiring 20–30 minutes of administration and paperwork time. Doctors don’t go to medical school to learn paperwork; every minute of paperwork erodes the rapport between them and their patients. Again there are many possible solutions, but one is more realistic: funding compliance programmes and measures to improve doctors’ work-life balance.
4. Back in 2009 the government was aware that “ageing of the population alone, if nothing else changes, will require between 40 and 70 percent more health workers if current standards of care and of access to care are to be maintained over the next 10 or so years”. The solution here is a simple supply and demand formula. Reduce demand with the measures in areas 1 and 2 and increase supply by addressing the doctor and allied health practitioner shortage.
5. With more than 25 percent of GPs planning on retiring in the next five years, about half of New Zealand doctors are experiencing burnout. With the government scrapping plans for a rural medical school in late 2018, the problem is going to get worse if nothing is done.
The retiring GP population and co-existing lack of locum doctors results in more and more GPs feeling the need to retire or amalgamate into corporate health ‘supercentres’. These centres further exacerbate the problem of patients seeing a different doctor each time. The solutions here, again, would be to make the speciality more attractive with better work-life balance and reimbursement. Adopting allied healthcare practitioners, such as physician assistants, nurse practitioners and prescribing pharmacists, would also assist.
These five elements affect young families the most because they are unlikely to all see the same doctor. The relevance of other family members’ health at the time a patient presents to their doctor is unfortunately underestimated.
I can’t emphasise enough that adopting a preventative/integrative medicine model would save millions, if not billions, of dollars and increase the likelihood of patients seeing the same doctor for longer, leading to better health outcomes.
It will take a mass movement to upend the archaic ‘old boys’ conventional medical training model and establishment. Thankfully, this movement is on the horizon, driven by patients’ desires for more than just a ‘pill for every ill’ and also by more enlightened health practitioners.