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Looking Forward

The object of the physician

By Joe McCue, DO


The old doctor once said that anyone can find disease, and as a good osteopathic physician, I won’t waste your time with another tired tale about the dropsy and myopia of the American medical system. We don’t need to talk about schizophrenic and disjointed care because as students, residents, and attendings, we live it every day of our lives.

As we slowly transition from the classroom to the clinic and from training to teaching, we become both more aware and more frustrated by the byzantine metrics our bureaucrats design—divorced from cost or clinical outcomes—in service to something or someone other than the patients we’ve pledged to serve. When every organ has the input of a highly trained specialist and every clinical question comes with inscrutable cost, it becomes rather hard for the patients themselves to be centered. And not one of us fails to feel it.

It is in these liminal spaces where we get to be the drivers of the change we so badly need. Making these subtle shifts can be a daunting task, but can also bring meaning to otherwise terrifying encounters such as the first time someone addresses you as “doctor,” or when you suddenly have no one senior to you checking your mistakes. I would like to propose a few solutions to help empower you to excel in these moments.

As a full spectrum family physician providing direct osteopathic primary and specialty care in rural Maine, I have gained some insights into finding the health of our profession. But before I ask you to listen to me ramble, let me tell you a bit more about who I am.

My path to medicine

I didn’t come to medicine early or easy. After four years in art school, three as a philosophy major, two studying radical education, and one completing medical pre-reqs with the aim of being a chiropractor, I finally discovered osteopathic medicine. Talk about a light-bulb moment. But first, I needed a degree, so with a decade in science ahead, I earned an English lit degree focused on marginalized voices critical of the dominant paradigm. Not the most traditional medical school applicant, I admit, but every step better prepared me for what lay ahead.

A little over a decade and two residencies later, I found I couldn’t give patients the care they deserved in a 15-minute office visit, even if I was taking all my charting home with me. So, I left and started a direct care practice. The transition was hard. It was frightening. And it was worth it.

A history of channeling personal struggle into systemic change made nothing easier and everything more coherent. Every misstep made my path clearer. Every stumble made me stronger. And every insecure moment of very real imposter syndrome was met with patients who praised my resolve. And it was worth it. These days, I spend an hour with most patients. We talk about their diet and their movement, their sleep and stress and mindfulness, their breathing and their posture, their structure and their function. We talk about their greatest hopes and deepest fears. I touch and I treat every patient. And they get better.

Doing what works

So how do we get to what works? The transition will be hard. And at times it will be frightening. And it will be worth it. All rational care is based upon the self-regulating and self-healing unity of body, mind, and spirit through the reciprocal interrelation of structure and function. That’s at the core of every osteopathic action.

So, let’s talk about a rational model of healthcare. And let’s get one thing straight: the American medical system is not broken. It is structured to function—and to fail—just as spectacularly as it does.

For starters, our insurance model is based upon the premise that not everyone needs or deserves access to the same basic healthcare. This premise isn’t great, but it worked out alright for at least most of our middle class when the middle class was booming, our foodways weren’t so fractured, and health insurance meant this thing called “major medical,” for which we paid a little and got a lot when things went awry.

Reducing poverty and inequity, growing our middle class, and arguing about universal healthcare are all well beyond the scope of this article, but we do need to talk about food.

Or rather we need to talk about where it comes from. Turn around any packaged foodstuff, whether cheezie puffs or veggie burgers, and you’re likely to see at least two if not all four of our most highly subsidized agricultural products: corn, soy, wheat and sugar. They’re also responsible for most of the refined carbohydrates and industrially processed seed oils wrecking our metabolic health. And as the core components in the concentrated animal feedlot operations that provide access to cheap, inflammatory meats for mass consumption, they’re wrecking our relationship to ranching as well.

To top it off, the monoculture methods used to grow and harvest these four agricultural products deplete nutrients from our soils, reduce carbon capture and biodiversity, and spill toxic chemicals into our waterways and our bodies. We are, quite literally, what we eat, and if we want healthy patients, we need healthy food. That means divesting from monoculture crops and redirecting those subsidies to regeneratively grown and nutrient dense plant and animal products.

Transitioning from an industrial mindset to a regenerative mindset will benefit our mental health as well. Laying aside the benefit of reconnecting to our food chain, improving the nutrient density of our foods while reducing inflammatory load creates measurable changes in both gut microbiome and, unsurprisingly, mental health outcomes. Taken even further, this transition involves stepping away from the industrialized mindset of our medical care model as well.

Finding meaning in medicine

The 15-minute office visit where a physician spends an average of 8 eight minutes in the room is both insufficient and traumatizing for patients and doctors. How is a patient to feel heard, to have questions answered, or to make truly informed choices about their care in such a short time? How are physicians to understand the complexities of care for each of these individuals, to know what they’re eating and how they’re sleeping, what they’re worrying about and how they’re moving about in the world?

It sounds like we need more time with our patients if we want to find our health. That means less visits and more doctors, and not just more doctors but more primary doctors with more time. The direct care model is providing one path to primary care that allows for this kind of truly individualized medicine, with lower costs, improved outcomes, and better satisfaction for both patients and physicians.

We eliminate much of the administrative burden of third-party payers and pharmacy benefit managers and we improve things for everyone. But even this is a stopgap. If we want more young doctors entering primary care, we need to make it feel meaningful again, to center it in the frontiers of science again. Rather than an average of eight hours of clinical nutrition, what if our doctors had 80? What if med school spent as much time on the science of the microbiome, mitochondria, and psychoneuroendocrine system (no I didn’t make that word up) as it does on the pharmacology we use to patch ourselves up? What if we spent our time on the therapies of touch and studied the emerging science of psychedelics?

Let’s retake healthcare in a primary way. Let’s retake our own health and the health of our system. Let’s get rid of the garbage we grow and manufacture and there will be no more garbage to eat. Let’s take the revolutionary decision to spend more time with our patients and less time on our reimbursements. Let’s spend our CME learning about what we need to grow healthy bodies and minds rather than fumbling around trying to fix sick ones at the limits of care. Let’s remake the structure of our system to function like we and our patients deserve to have it work for us.

Let’s grow our food and our practice and our minds to match the limits of our imagination. That transition is already under way, and it’s just a matter of finding our path and removing the barriers for it to flourish. Any rational treatment demands no less.