Medical Care Delivery

Is it all in our heads? Are our assumptions about sickness and going to the doctor based on sound science, or something else? Maybe not all of them, but maybe some of them are. What is good health?

Here’s a book that offers something more than the usual approach to the current health care delivery system. Dr. Nortin Hadler expresses little patience with many of the sacred cows of traditional and nontraditional medicine, and offers plenty of evidence for his view that Americans are being overtested and overtreated. It’s called Worried Sick: a Prescription for Health in an Overtreated America (University of North Carolina Press, 2008).

Hadler is a rheumatologist whose field is musculo-skeletal medicine. He is concerned with what he calls overmedicalization, which is policy based on common assumptions perpetrated by doctors and the popular press. Hadler shows that many treatment assumptions result in unneeded interventions and drugs that offer little improvement in patient conditions. He calls it Type II Medical Malpractice – “doctors doing the unnecessary, albeit very well.” This compares with Type I Medical Malpractice, “which is doctors doing the necessary unacceptably poorly.”

Hadler offers a social construction for illness, based on his research into socio-economic status of peoples, not just individuals. And his evidence points to causes of illness in many people due to their situations in society, their families and workplaces. He differentiates illness from disease. He carefully presents his view that people go to the doctor with pains or conditions that would be tolerable if they were in different socio-economic positions. He says in his introduction, and spends the next hundred pages explaining, “Once I educate you, you will be able to go before your physician with such complaints as ‘Doc, I feel awful. Could it be in my mind?’ or ‘Doc, my back is killing me. I can’t figure out why I can’t cope with this episode.’”

His point is to teach well people how to navigate the health delivery system critically. He understands that there are circumstances that require one to go directly to the doctor in order to survive, but that is not the focus of this book. He deals with doctoring for heart disease, stroke, blood pressure and blood sugar issues, cholesterol screening and treatment, aging, metabolic syndrome and more. For example, about metabolic syndrome, he says, “Do you really think that 43 percent of Americans age sixty to sixty-nine should be medicalized as having the Metabolic Syndrome? Could it be that this definition [reported in the book] is nonsense?” Hadler offers a list of treatments for various conditions that he says do not qualify as effective because their benefits are barely measurable.

He gives his solution to the problem. He advocates overcoming “misdistribution and the inconsistencies in the quality of care,” to prevent sickness and heal when prevention fails. He says that first medical treatment must be effective, then of quality, since quality treatment is good only when it helps someone. He wants “rational, not rationed, health care.” He has a plan to finance and carry out his proposition in the United States. It sounds different from what others are saying.

This book is extensively documented and based on much research. Hadler is professor of medicine and microbiology/immunology, and has written other books, including The Last Well Person: How to Stay Well Despite the Health-Care System, which is on the same subject.