In “The Wealth of Nations,” Adam Smith identified the activities that created “real wealth” and those that didn’t. If he were alive today, I’ve little doubt that he’d be fascinated by the medical world, and our attitudes to health. He’d immediately notice that many pharmaceutical companies are wealthy, not so much because they produce exceptional products, though some do, but because many of the drugs they sell are to people who don’t need them but think they do.
Patients with minor ailments – sometimes, imaginary ones – demand quick fixes from their doctors. Doctors oblige, often writing prescriptions for unnecessary drugs just to keep the patient happy. The patient feels better, the doctor makes a quick buck, and the pharmaceutical company’s bottom line improves. Everyone’s a winner. Yet, for numerous reasons, this is a bizarrely dysfunctional system. Let’s take an “Adam Smith” approach and look at the economics of the situation. The doctor spends about ten minutes with the patient who pays around $100 for the consultation. Even if the doctor doesn’t have a continuous stream of ten-minute consultations, that’s a high rate of pay by any measure. Ideally, the doctor should devote enough time to each patient to chat and reassure, to carry out a basic examination, and to prescribe medication if clinically indicated. A reasonable amount of probing dialogue alone would take more than ten minutes, which suggests that some doctors see theirs as a moneymaking profession as much as a caring one.
Patients are not blameless. Many come for an instant cure, are not interested in prolonged examinations and discussions, and may change doctors if they don’t get the kind of treatment they want. Regardless, doctors should insist on carrying out full, unrushed consultations, and refuse to prescribe drugs that are not indicated. They’ll make less money that way, but their first responsibility is to take care of patients, whether patients agree with the way they do it or not. Doctors are obviously the experts and they must have the courage of their convictions even if it means fewer patients and less money. Greed – whether a banker’s, a broker’s, a grocer’s, or a doctor’s – rarely works in the customer’s best interest. Indeed, when our doctor sees us as a customer rather than a patient, it’s time to switch doctors.
Doctors must change, but so must patients. In fact, long before we ever become patients, we should be taking responsibility for our own health. Unless we have an illness, nobody can provide us with better preventative healthcare than we ourselves can. And we don’t need a medical degree to do it because most of it is common sense and detailed information about it is widely available. It comes down to three main areas: diet, exercise, and relaxation. The first – what constitutes healthy eating – is no secret, but whatever we eat must match how much we need as fuel. Put simply, we need to eat more if we exercise more. But the devil is in the detail, as the saying goes. Our dietary balance is crucial: we should significantly reduce our consumption of animal fats, refined sugars, and salt, and increase our intake of fresh fruit, vegetables, lean white meat, and fish. Apart from food, we should drink lots of water and very little alcohol. And we should definitely not smoke.
Along with a balanced diet, we need an exercise regime. I choose the word “regime” intentionally because it implies a routine that’s been well thought out. If we’re not in a gym or play energetic sports, we should take regular exercise that raises our heartbeat, such as a brisk thirty-minute walk every day. Whatever form of exercise we pick must be practical, so that it can be performed every day. For example, we might decide that a brisk walk to and from work would satisfy our daily exercise goal, but if we live in a region with regular bad weather, that wouldn’t always be practical, so more than likely, that exercise plan wouldn’t last long.
Exercise has the additional benefit of reducing stress, but it’s a good idea to practice other relaxation techniques too, so that we can feel energized and rejuvenated to face the world in an optimistic mood every day. I’ve written a separate blog on that subject, so I won’t elaborate here. The blog is called “Always Be Positive.”
The bottom line is that nobody has more responsibility for our health than we do. By taking steps to be mentally positive, get regular exercise and control our diet, we’ll be healthier, need fewer visits to our doctor and save money. Adam Smith would be proud of us because he hated waste. It seems he took good care of his health too, since, though he died at 67, he lived to nearly twice the average age for a man born in early 18th century Britain.
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