Americans want doctors to talk about more than sickness

Many Americans want a different relationship with their doctors that goes beyond treating sickness, according to a recent survey from Samueli Integrative Health Programs.

The vast majority of Americans––nine out of 10––agreed that health means more than just treating sickness. When asked to define health, Americans identified many other factors, including being happy (59 percent), being calm and relaxed (56 percent), and the ability to live independently (53 percent).

Almost half of U.S. adults––45 percent––with a primary care physician said they wished their doctor asked them why they want to be healthy, according to the survey. This result underscores that many Americans are interested in care that focuses on wellness. Fifty-seven percent of younger people aged 18 to 49 also said they wished their doctors would talk to them about treatments that don't involve medication. 

“For most Americans, health is about far more than just not being sick. It includes factors such as being happy, being calm and relaxed, and being able to live independently.,” Wayne Jonas, MD, author and executive director of Samueli Institute, told HealthExec. “Mental health issues were prominent. These are all a part of the behavioral and social determinants of health, and research has shown us that these factors greatly influence a person’s health.”

Samueli Institute is a non-profit medical research organization that supports the scientific investigation of healing in the areas of stress, pain and resilience. Jonas, who authored the book “How Healing Works,” served as president and CEO of the organization from 2001 to 2016. The survey, conducted online by The Harris Poll, queried 2,000 adults ages 18 and older.

The results also revealed a wide difference between patients and doctors on the meaning of health.

“Unfortunately, this survey showed that a majority of those who have a primary care physician say they don’t talk about much more than their medical needs with their doctor—and many wish they did,” Jonas said. “Particularly, those who are younger. So, while the 'textbook definition' of health for patients is broadening, the way healthcare providers address their health does not seem to be.”

Treating sickness

A big part of the problem in treating patients for overall health, including wellness and preventive care, is the way the current healthcare system incentivizes treatments.

"Our current healthcare system is set up to treat a patient’s symptoms, mostly on a treadmill-like volume basis, instead of promoting their wellness by preventing their disease or ailment in the first place or trying to reverse it once they have it,” Jonas said. “Often times when patients go into the doctor’s office, there is already a 'quick fix' that can easily be prescribed for their symptoms, using pharmacological remedies, which are paid for by insurance.”

This means that patients aren’t always being treated for the underlying reasons that cause diseases, including social determinants of health. Doctors are not necessarily trained on the social, behavioral, personal and environmental factors that contribute to chronic diseases.

More than half of respondents said their doctors don’t talk to them about much more than their medical needs. A whopping 74 percent of Americans with a PCP said they discuss their physical health with their doctors, but only 51 percent discuss exercise; 44 percent discuss diet; and 40 percent talk about sleep. Even fewer said they discuss mental health (36 percent) and spiritual health (10 percent).

These findings come at a time when more Americans are diagnosed with a chronic disease––48 percent have such a condition, including 18 percent of Americans diagnosed with anxiety and 19 percent with depression, according to the survey.

Barriers to health

Both patients and doctors agree time is an issue to covering more aspects of health beyond physical wellbeing and sickness.

“The relentless demands of the modern healthcare system force us to use most of our time dealing with a vast bureaucracy of insurance regulations, digital record-keeping and volume-driven visits,” Jonas said.

However, small changes could make a big difference to patients. Instead of looking at the issue with a need to change the medical infrastructure, a fundamental shift in thinking during office visits or e-visits with patients could help better evaluate health, according to Jonas. For example, asking questions related to other aspects of a patient’s life during a visit could facilitate health, including asking patients what matters to them.

There are some bright spots that the healthcare system may be taking into account a greater understanding of health, particularly when it comes to treating and preventing chronic conditions.

For example, a new consensus report form the American Diabetes Association and European Association for the Study of Diabetes calls for such a shift in the treatment of type 2 diabetes to take into account all lifestyle aspects of patients, putting the patient at the center of the care plan, according to Jonas.

“We are seeing changes within our healthcare system that support physicians who do work to treat the patient, rather than just their symptoms, but we have a long way to go,” Jonas said.