I believe the purpose of health care is to help a person improve their quality of life through helping them grow in physical and mental wellbeing. For most of us who went into medicine, this was and is our objective. The problem is, we are attempting to do this within the confines of a health care system that not only makes it difficult to pursue well-being, but literally detracts from such. Our current health care system prevents human flourishing, prospering, thriving.
According to research in positive psychology, well-being requires feeling positive emotion. The PERMA model proposed by Dr. Seligman suggests that positive emotion is the ability to remain optimistic and view one’s past, present, and future from a constructive perspective. Being able to stay optimistic comes from being able to believe things like: "I'm going to be okay." "Everything's going to be okay." "I know what I'm doing and where I'm going." "Though a lot of things aren't in my control, there's a lot I am in control of." "I have the resources I need to take care of myself and my family.” “I can handle anything that comes my way.”
Our health care system makes it very tough to believe these things. There are a few reasons why.
Lack of Price Transparency, Surprise, and Exorbitant Costs
Many, if not most, people don't know what their health care will cost them. They don’t know if they’ll be able to afford a test or treatment proposed by their doctor. They don’t know if they’ll be one of the roughly 530,000 families who go bankrupt or one of the nearly 140 million people reporting financial hardship this year related to medical bills. This scenario creates a perpetual undercurrent of feeling uncertain or pessimistic, which necessarily chips away at well-being. In response to feeling uncertain, many people will forgo doctor's visits and maintenance medication, potentially furthering them from health and well-being. Imagine a health care system in which people knew up front what a test or procedure or surgery might cost them. Or better yet, imagine a system in which no one ever had to worry about choosing between a needed medication, surgery, or procedure or their mortgage, rent, car payment, or groceries.
Lack of Knowledge Regarding What You Get for Your Premiums
Many, if not most, people don't know what they're getting in exchange for the money they put into their premiums. They understand that most things they pay for display an immediate exchange of goods and services: if I pay $20 I get this entree at dinner. If I pay $850 I get this refrigerator. If I pay $5 I get this Starbucks drink. The money going into premiums doesn't have any obvious return, at least certainly not an immediate one (except those who have "good" insurance and are confident their bills will be covered, in which case they may feel peace of mind as the immediate exchange for paying their premiums). Furthermore, many pay their premiums then still get a $50,000 bill for a CTangio to eval for nutcracker syndrome (yes, this just happened to a patient of mine) and then truly see no value in their premiums. This lack of value fosters feelings of anger, desperation, and helplessness, and all detract from well-being. Imagine a system in which we knew what we were getting in exchange for the money we invest.
Lack of Foundational Resource Access
Resources such as PT, OT, mental health services, addiction support, dietitians, life coaching, etc are not available to all. We’re in a system in which only the “well-insured” or wealthy have a chance at accessing the resources they need when they need them. This is particularly crucial in our current society in which mental health crises and obesity are seriously impacting the quality and longevity of our lives. This contributes to people feeling stuck or ineffective in their own lives. Imagine a system in which we had a robust foundation of such resources accessible as the first line of health care. This would help create a society in which we proactively seek well-being and attend to mental and physical health problems in the early stages, as opposed to when in crisis (as we so often are now).
Lack of Time Spent with Their Doctor
I regularly hear complaints from patients about doctors being rushed, not listening, not spending enough time. Presumably this is not from doctors wanting to be unhelpful; rather, it’s the natural byproduct of working in a system that is a money making business, demanding more and more productivity from doctors. This leaves less time with patients, leading to patients feeling dissatisfied and frustrated. Imagine a system in which we had the time and resources to adequately address our patients’ questions and concerns.
All of the above increases distrust in our health care system, meaning an increase in believing things like, “I don’t know if I trust my doctor,” “I don’t know that they have my best interest in mind,” “I think they’re just pushing medicine on me,” “I think they may just want my money.” This leads to people feeling cynical and skeptical. Even if subconscious, and certainly if conscious, these thoughts and feelings drive a wedge between the doctor and patient; lead to an overly negative view of doctors and their actions; lead to people avoiding going to the doctor or ignoring the doctor’s advice; or may lead to people ignoring their health altogether, thinking they don’t have a place to turn for help in the health care system and not knowing where else to look for guidance.
I doubt most people are spending much time consciously sitting around thinking about how much time their doctor spends with them, how much their medical bills might cost, etc. But, that doesn’t matter: the framework is there. The brain is constantly scanning and interpreting incoming data, and the data it’s being fed from our health care system facilitates the creation and perpetuation of such negative beliefs, leading to feelings that are far from the “positive emotion” Dr. Seligman purports is necessary for psychological well-being.
I don't believe our current health care system is the only "system" in America creating such a difficult environment in which to thrive, but it's certainly a contributor. Whether it's conscious or not, all of the above detracts from the ability to believe what is necessary to flourish. With our current health care system, we're setting up our country to be full of people who are in chronic stress, chronic scarcity, chronic uncertainty, and chronic skepticism, all of which detracts from human thriving. We have to do better.
Yes, I believe the goal of the health care system should be to help people improve their quality of life, but I don’t think we should settle for interpreting that to mean just fixing or putting bandaids on ailments as they arise. I think a health care system has an opportunity to contribute to our species’ ability to truly thrive, something we are arguably not seeing for most of our country’s inhabitants. In order to thrive, we need to collectively experience optimism in thinking of our pasts, presents, and futures. And in order to do this, we need to have systems and processes in place that at the very least don’t contribute to and foster pessimism, cynicism, uncertainty, and fear; and at their best make it easy to believe we have every reason to be optimistic about our pasts, presents, and futures. What would that health care system look like? It’s time to dream it up.
Melissa Kwak, MD is a family physician practicing full-time. She found a way out of burnout and is helping other physicians do the same through her life coaching practice. Dr. Kwak is a 2019-2019 Doximity Fellow. The article is her own and doesn't necessarily represent her employer's positions, strategies or opinions.