Here at HolSpan, we strive to challenge our patients and clients to reframe “conventional” thinking and conventional medicine. A fundamental consideration is how we view health and wellness in the background of illness and death. This overview spectrum is a helpful visual tool to understand better the approach of current medical care and the role of wellness.
Conventional medicine typically operates on the far left (red/orange hues which are informed by signs and symptoms of disease). The goal is to move people to the right (typically only to the neutral point). Notice how the neutral point represents “no discernable illness,” while health and wellness continues to lie further to the right (blue and purple hues).
Practical Urological example:
Wellness paradigm
Practical general example (using frailty):
Wellness paradigm
As a clinician, I have seen many people who self-identify as “healthy.” Often the default assumption was that if a patient had no diagnosed medical conditions or did not take any prescription medications, they must be “healthy” (a common mistake). Oftentimes this “healthy” label did not match the patient nor the reason I was seeing them (infertility, sexual dysfunction, amongst others). These observations led me to reflect on my experiences as a surgeon/clinician balanced with my prior background as an athlete. Below is a working model I conceptualized before finding the Illness Wellness Continuum:
To the left is sick care. Much of our efforts as clinicians (along with health care resources/expenditures) are devoted to this group. We strive to get people out of this group. This group can be further subdivided broadly into:
Most would agree that the American medical system does a great job managing acute sick care. Our high-priced, high-tech system shines when faced with these maladies, rescuing people from life-threatening events (strokes and heart attacks). Chronic disease care seems to be another story. Our system seems to perform rather poorly in helping these patients. These patients tend to be managed with chronic interventions instead of rooting out underlying causative factors. The tools used to address acute concerns often do not work as well with chronic conditions.
Upon closer inspection, the line blurs between chronic and acute concerns in many areas as acute manifestations from chronic disease processes are cyclical.
The next logical question to most should be, “How do we help prevent chronic disease and get people healthy?” Things remain just as murky as we get to “healthy.” What does that even mean?
Most providers would define this as “free of disease/illness.” Again, that is not very helpful for our purposes. Most metrics used in labs and population-based guidelines used to objectify this are limited by the fact they are population-based estimations. I would argue that this is more an approximation of common expectations vs. healthy normals. This is an important point to understand. Common is not the same as “healthy” or “normal.” That said, most people are directed from “sick” to “common” not necessarily “healthy.”
Throughout my training and clinical practice, I harbored resentment. A resentment that I kept to myself for some time. I could not understand why we used different tools/tactics to keep people healthy compared to strategies used in the athletic world that I was in before pursuing a career in medicine. Most of my life before medical school was pursuing the right-hand side of the model above (optimization/enhancement). The tactics were always laid out in a very straightforward manner with a focus on:
This may all seem like an exercise in semantics, but it is important to have this framework in mind when being honest with where you are and where you intend to be (goal setting). Future posts will layer in important conditions that can serve as benchmarks to help us discern if we are transitioning into different aspects of the continuum (for better or worse).
An important theme (a recurring one at a foundational level) will be to bring awareness to this process/continuum as it will serve as a framework for our overarching care plan. You need to understand this roadmap to help give an honest assessment of where you currently are and where you hope to navigate.
The motivation for this post came during the COVID-19 public health crisis. Sadly, this crisis put the themes I describe above under the microscope. A large component of people in the sick care section who were “otherwise healthy” were severely impacted, with some regions disproportionately impacted based in large part on the numbers of sick and unhealthy patients in their baseline populace. Many lessons were learned from this crisis. The most important lesson may have been that each individual should pursue a baseline health optimized at a minimum. Being “healthy” in a sick care model is no guarantee for health. The sick care system is also not a guarantee (in its structure and sustainability).
“It is no measure of health to be well adjusted to a profoundly sick society.” -Jiddu Krishnamurti
Sources:
HolSpanMD counsels patients on a personal level to achieve their optimal metabolic health, focusing on precision wellness and preventative care. Reach out to us today to schedule an appointment or ask a question.
schedule an appointment
