We Need Health Care Instead of Disease Management

Interesting read from a medical student’s perspective…

Source: KevinMD

I always wanted to become a medical doctor to cure the sick and save lives. In fact, most doctors I know chose the profession for the same reason. This fundamental desire among physicians to treat patients is because our beliefs have been deeply rooted in the concept of disease management rather than the provision of health care.

As an aspiring physician and student of health care, I often catch myself heading to the physician’s office to be treated for a condition, rather than prophylactically for health maintenance. When I get to the doctor’s office I end up seeing the doctor for what seems like only a few minutes, before they write me some prescription and hurry me out of the office for the next patient to come in.

Interestingly, my health insurance will cover and reimburse such on-demand sick visits and prescriptions more readily than frequent health and wellness checkups where I am simply able to sit down and talk to my doctor about my health goals.


With rising costs, expanding patient populations, shortages of physicians and nurses, and the growing prevalence of chronic diseases, I have to question if doctors have it right.  Is it better to cure the sick, or instead focus on enabling a nation of the healthy?

I started to think about this when I co-led a group of 40 students on a medical brigade to the Panamanian jungle recently. I envisioned us setting up our clinic to treat the sick in the classic U.S. “conveyor-belt” style, with patients moving from triage to consultation to dental to patient education and finally to pharmacy to pick up their meds. I thought that by doing so, we would effectively manage diseases, cure the sick, and save lives. I was wrong.

On my first day of clinic, no patients showed up. Rather than sitting around in the consultation room doing nothing, I decided to spend the day playing with children in the playground.

I was upset. I had expected to be the “doctor,” to give out medicines, to feel like I was making a difference. Instead, I used my time to swing from monkey bars in the playground with healthy children who had nothing to do and no place to go. I felt like I was making no impact at all.

When I arrived to the clinic the next morning, something happened that made me change my mind. Waiting for me at the entrance was a young Panamanian child named Michael, with whom I had spent the previous day playing. When I got off the bus, Michael ran up to me, gave me a hug, called me his “amigo,” and pulled out a cake from his lunch bag, which he gave to me as a present.

Immediately, I choked up — here was a child who lived in extreme poverty and did not know when his next meal would be, yet he valued the time and attention I had given him so much that he gave me the cake his parents had packed for him. That’s when it hit me, that a simple gesture of attention to one who needed it was making as much difference in the provision of care as any medicine could … maybe even more.

Following this experience, I pushed to abandon the conveyor belt philosophy for a new way of thinking in managing patients. While I knew that disease management would be inevitable, my goal was to focus on health care. I was lucky. A few doctors in my brigade felt the same.

As an observer, my most memorable case of witnessing meaningful health care was a woman complaining of headache caused by stress. After some probing, she revealed that her twins had passed, and she could no longer have any more children. Since she now only had one living son, she was too scared to let him leave the house for fear of something happening to him, and this contributed to her headache.

This woman clearly did not want nor need medicine; she just needed someone to talk to, someone to listen and just let her know she was being cared for. She left the clinic that day a healthy and hopeful woman, having received 50 minutes of one-on-one quality care with a physician. While she instigated the visit because of illness, the greatest benefit to treating her was simply to provide empathy first, followed by a plan for her health care that she could agree to and follow.

Benjamin Franklin once said, “The best doctor gives the least medicines.”  During my week in Panama, I learned that the fundamentals of medicine do not lie in giving out millions of medications and seeing as many patients as possible, but rather in instilling in patients the vision for their own health by providing them a compassionate ear, professional guidance, and quality time.

Above all else, this is what medicine must be about.

Robert G. Dorfman is a medical student.