The Need for More Health Science in Health Care
When the sick are told to put their lives in the hands of someone unqualified to treat them, we know there is a problem. When the healthcare industry is complicit in the situation, we know there is a crisis. Nevertheless, this is the reality of the current health model. A fundamental change is necessary, and Health Science might be the answer.
Several leading causes of death directly result from things most physicians are not educated about (CDC, 2019; Cardinal et al., 2015; Adams et al., 2015). The increase in such deaths is equally alarming to the rise of related chronic diseases rooted in the same causes. However, healthcare leaders currently seem unsure about the appropriate course correction. Almost paradoxically, the solution may be rooted in something often seen by medical professionals as alternative care.
Health Science and Health Science professionals help fill the education and treatment gaps plaguing the healthcare system. They can provide a positive impact on overall and long-term health and wellness. There is a desperate need to include Health Science in health care on several fronts. However, to effectively course correct, we must first accurately identify the problem, understand its true source, and then detail potential solutions.
Purpose of this Review
This review aims to help define one of the healthcare system’s many issues and provide a potential solution for the problem being described. At the very least, this review might provide alternatives to explore when faced with conditions that fall outside the expertise of many medical doctors. The hope is that advancements and innovations in medical practice and chronic care can be achieved by raising awareness of said issues and options.
To appropriately address any problem, that problem must first be correctly identified. While it would be near impossible to discuss every element of what is broken, we can explore some of the obvious. Hence, we will cover some of what is broken, the associated costs, the poor outcomes, the root of the problem, and a potential solution to explore.
A Broken Health Care System
Poor healthcare practices are not a new issue. Experts from RAND produced a study in 2003, claiming that Americans generally received about half of the recommended medical care processes they require (McGlynn et al., 2003). The researchers of the study suggested that the lack of proper care posed a severe threat and that despite interventions by leaders in both government and health care, such problems persist (McGlynn et al., 2003).
Such issues continue. According to a recent report by the Commonwealth Fund, when it comes to health care, the United States repeatedly ranks highest in cost and last in overall performance compared to other high-income countries (Schneider et al., 2017). Holistically, the researchers point to poor access to the correct medical professionals, delayed diagnoses, overuse of technologies and drugs, coordination and safety problems, and inadequate prevention and management of chronic diseases as significant sources of trouble (Schneider et al., 2017).
The Bad Investment
Money is a considerable portion of the problem, and that part is getting much worse, according to a study from a team led by a Johns Hopkins Bloomberg School of Public Health researcher. Anderson, Hussey, and Petrosyan demonstrate that healthcare spending in the United States has grown faster than in any other leading nation (2019). The research team points specifically to the higher prices for services and drugs and higher salaries for medical professionals and hospital administration (Anderson et al., 2019). The study echoes the previous studies in the idea that this increase has occurred despite efforts by leaders to control spending.
Some medical professionals suggest that the return on investment is not there. According to Sanjaya Kumar, chief medical officer at Quantros, and David B. Nash, dean of the Jefferson School of Population Health at Thomas Jefferson University, doctors often make bad treatment decisions that are not proven to be effective and that are both scientifically flawed and generally dangerous (2011). These researchers argue that reduced safety, poor quality of care, and overall waste are quite common (Kumar & Nash, 2011).
The Poor Outcomes
Collectively, poor access, poor quality, safety issues, delayed diagnoses, abuse, and poor management of chronic diseases often result in adverse outcomes. An estimate provided by John Hopkins University in 2016 found that over 250,000 deaths occur yearly because of medical errors (Makary & Daniel, 2016). Attempts to dispute that estimate have found lower but still rather alarming conclusions. For example, in a 2019 study, researchers found that roughly 120,000 deaths could be attributed to adverse events related to medical care (Sunshine et al., 2019). Studies are ongoing to pin down a more reliable estimate, but these stats are alarming.
The Root of the Problem
The root of this systemic problem might be found by first examining chronic diseases and the leading causes of death. According to the CDC, sixty percent of Americans deal with some kind of chronic ailment (CDC, 2019). Furthermore, the leading causes of death in the United States result from chronic diseases such as heart disease, cancer, and diabetes (CDC, 2019). However, it is essential to note that a recent study published in PLOS One suggests that such diseases are not genetic or communicable. Instead, the study echoes the CDC by suggesting that more than 85 percent of chronic disease is caused by lifestyle choices that include diet and exercise (Rappaport, 2016).
Diet is foundational in health, but nutrition is not a focal point in the training of most physicians. According to research by Jennifer Abbasi, many medical students do not get an appropriate education regarding nutrition (Abbasi, 2019). Abbasi’s findings are supported by a 2015 survey that found that 71 percent of medical schools provide less than the recommended 25 hours of nutrition education and that over a third of all schools provide less than half of that (Adams et al., 2015).
Similarly, exercise is essential for health, but again, not something that many physicians are required to learn. In a 2015 study of allopathic and osteopathic medical schools, researchers found that only 12.2 percent of medical students had a single required course related to physical activity (Devries et al., 2017). A study conducted in 2015 by Cardinal, Park, MooSong, & Cardinal, demonstrated that over half of all American physicians receive zero formal education in physical activity (Cardinal et al., 2015).
Making a Change
Leadership is at the heart of both the issue and the solution. Decisions must be made, and process mistakes must be corrected. However, this may be easier said than done. A 2004 study by Edmondson found that not only do many in health care not learn from mistakes, but an alarming 86 percent of process failures in a health care setting were caused by unnecessary or incorrectly executed actions that could have been avoided with proper information distribution (Edmondson, 2004).
Health science is a multidisciplinary component of health care that seeks to improve health outcomes by developing knowledge and interventions for general health and wellness and disease treatment and prevention (Nature, 2020; ScienceDaily, 2020). In a special report in The West Indian Medical Journal, Health Science was featured as a hope for health care because of its orientation around etiology, exercise, nutrition, health policy, health education, and health economics (Ashraf, 2015). The journal notes that a total understanding of Health Science’s applications will take some time but that not only is Health Science one of the fastest emerging fields in the health industry, its practice often results in improved outcomes and overall better health management (Ashraf, 2015).
Dr. John Kotter suggests an eight-stage process for change. These include establishing a sense of urgency regarding the issues, creating a guiding coalition, developing a vision and strategy, communicating the vision, empowering workers for broad action, generating short-term wins, consolidating gains, and anchoring the new approaches in the overall culture (Kotter, 2012). However, it must be noted that real change is often marked as significant transformations in people’s attitudes, behaviors, and values (Shriberg et al., 2005, p. 208).
The data demonstrate a systemic problem in the current healthcare model. Performance issues, mistakes, high costs, inadequate training, and improper treatments are regular complaints. Leaders in health care are failing to set the appropriate standards. To make decisions regarding the correction, leaders must first see the obvious and course-correct. An easy first step would be greater Health Science inclusion, as this would likely alleviate many of the ailments plaguing the healthcare system. While change can be difficult, following Dr. John Kotter’s proposed process would make such a change much more manageable.
As a nation, we must understand how health care is failing and how leadership allows these issues to continue. The literature demonstrates several opportunities for improvement. However, innovations are sometimes hard to implement, especially when faced with cultural norms, a refusal to learn from mistakes, and resistance to change.
As demonstrated, Health Science is relatively new, and the potential of its application is still being explored. A clear vision of what Health Science can or should do has not yet been developed. While the youth of Health Science can be seen as a benefit regarding the enormous potential and opportunities this youth affords, it also poses an issue regarding immediate referral and inclusion, let alone any cultural alternations. As of the time of this publication, Health Science is not considered a front-line component of health care. Of course, being relatively new and somewhat unknown, such inclusion would likely not be top-of-mind in a practice setting. This is especially true regarding otherwise unaware, uneducated, or unappreciative physicians.
Regardless, and according to the literature, the urgency for change is evident. The dramatic rise in chronic disease, health-related costs, poor access to health professionals, and the alarming rate of medical neglect prove that something is systemically wrong. As addressed, the leading causes of death are related to diet, exercise, and physician mistakes. Ironically, most physicians are not adequately trained in either diet or exercise and often give terrible advice regarding diet, exercise, and various nutraceuticals. This ignorance might help explain the explosion of diet and exercise-related chronic diseases. The cause and effect are simple; if one is fundamentally unaware of something, one cannot understand, counsel, or treat someone on that topic. Ultimately, this equates to more patient visits, uneducated advice by untrained doctors, improper treatments, the inability to guide patients on how to treat at home, higher costs, and the absence of long-term strategies for overall health and wellness.
Leaders in health care do not require diet and exercise training, as evidenced by the continual hiring of physicians despite their lack of proper education. Similarly, education leaders are not making the appropriate changes to the curriculum despite the alarming rise in chronic diseases related to diet and exercise. There appears to be no unified coalition attempting to rectify these issues. Perhaps effective communication regarding the potential for Health Science to help remedy such issues has been lacking.
Similarly, while Health Science has enjoyed some short-term wins, such wins have mostly gone unnoticed, evidenced by the lack of awareness. Regardless, when leaders in both education and practice fail their physicians by not equipping them with the appropriate knowledge, they set the physicians up to ultimately fail the public, as physicians are ill-equipped to address even the most straightforward behavior-related conditions.
Chronic diseases require a different kind of care from that of acute illnesses. Delayed diagnosis, improper care, unproven strategies, and symptom management, as opposed to seeking a cure, would increase costs while endangering the patient with various issues ranging from potential dependency issues to death. This seems unnecessary when many answers seemingly stare us in the face.
No matter how we look at it, we must admit that current healthcare initiatives are failing, and physicians must admit their ignorance. The rise in disease, deaths, and costs is significant. Both policy and education have failed physicians. By failing physicians, they have also failed the public. The need for a different approach is both evident and urgent.
Health Science could play a much more prominent role, but leaders in health care need to initiate the change on several fronts if that is going to happen. Logically speaking, it would be wise for a specific health-related issue to be handled by those trained to address it. Furthermore, it would be unwise for a single group to monopolize potential care options. Leaders need to open a dialog to see what can be done to adjust the culture to ensure proper care is being provided to patients and that such options remain available. Such a change is likely rooted in education and proximity to other healthcare professionals.
Research Findings & Observations
Diet and exercise-related issues need to be addressed by those explicitly trained in diet and exercise. If not properly trained, physicians must admit to themselves and their patients that they are not the expert on the etiology of various chronic diseases, nutrition, and exercise and then refer their chronically ill patients to the right allied professionals.
Allowing Health Science professionals to play a more prominent role in overall health care would increase options for patients and doctors, increase access and knowledge, reduce costs, reduce burdens on physicians, reduce waste, and likely result in better outcomes as patients see the appropriate health professionals for their conditions. Logic dictates that health care would be improved on several fronts. Opportunities should be explored.
Leaders in Health Science, health education, and medical practice must collaborate to enhance the vision regarding the role that Health Science can or should ultimately play. At the same time, healthcare culture should be encouraged to see both as fundamental rather than look at nutrition and physical activity as alternatives. As a result, attitudes, behaviors, and values regarding Health Science initiatives would likely improve in the public’s eyes and medical practice.
To achieve this standard, Health Science professionals need to be provided with more opportunities for inclusion in overall health initiatives. Accordingly, Health Science professionals must seek out such opportunities when possible. If nothing else, physicians should confer with a trusted Health Science professional when treating a patient dealing with such issues, and patients should request such backup whenever possible.
Health Science can and should play a more significant role in overall health care. Doing so will generate new treatment options for both physicians and patients. Physicians and Health Science professionals should build better relationships to ensure that a physician has the opportunity to refer appropriately. Furthermore, collaboration may also increase and advance innovations in health as more challenging cases are examined and treated.
Alternatively, and long-term, leaders in health care and health education must make the appropriate adjustments regarding initial education, continued education, and hiring practices of physicians. At the very least, the minimum education hours can remain, but it must be stressed that referrals for such conditions are essential. Furthermore, and regarding the education itself, such education should be carried out by those adequately educated in Health Science specifically.
As a rapidly expanding healthcare component, trained professionals are available to help treat patients’ chronic diseases. These trained professionals must play a much more significant role in the healthcare industry. The urgency is evident, and a vision has now been proposed.
As demonstrated, there is an urgency to improve health initiatives. Behavior-related diseases are on the rise. Understanding behavior requires communication and understanding. Therefore, the answers we seek from patients will not be found in short visits, complicated medical jargon, and increased costs. Instead, the answer likely resides with professionals trained to look for, examine, and treat such diseases and identify methods necessary to help correct the behaviors that drive them.
A vision has been proposed regarding the greater inclusion of Health Science professionals. The question of what this might ultimately look like remains unanswered. A coalition must be formed to develop strategies to ensure Health Science inclusion and referral. Leaders must take the lead. Communication and education efforts must ensure that physicians are both aware and confident in the inclusion and referral process.
Reason dictates that the risk of maintaining the status quo is a continued and dramatic rise in disease and death. Any step in the direction of the proposed vision would likely see a great benefit. As an industry, already established short-term wins can turn into long-term victories as Health Science professionals are empowered to do what they do best. These new approaches can eventually be anchored in the healthcare culture and would likely result in a considerable reduction and better understanding of the diseases.
Limitations and Future Study
Several limitations and potential areas for future research must be considered. For example, Health Science professionals are generally regarded as allied health professionals and are not yet considered a primary part of health care. Furthermore, it is not universally known whether it would be a good idea to put Health Science on the front lines or what that might look like if it were. Research regarding these potentials would be wise to endeavor.
Additionally, Health Science specialties are still being developed and explored. Further research is necessary regarding the age spectrum, gender, and various lifestyles to better understand and refine both its application and potential. As of this publication, studies regarding the efficacy of Health Science in practice are scarce. The full scope of the application of Health Science is still mostly unknown.
Finally, research addressing education initiatives for physicians regarding nutrition and physical activity is hard to come by. While it is known that some universities require this type of education, it is clear that others do not. Whatever that might ultimately be, the potential for consistency remains a critical gap that must be addressed. Research regarding how this could be achieved or how the field of Health Science could help in that endeavor should be initiated.
There is much to discuss and many opportunities for improvement. However, any step in the right direction would greatly benefit everyone because the risk of doing nothing is more of the same issues identified in this review. The proposed vision sees a future where medical doctors and Health Science professionals work together to care for ailing patients. While their roles and purpose are ultimately different, the need for both is clear.
Research is needed to develop a more robust version of this vision and explore how such a vision could be implemented. As Health Science progresses and matures, there will likely be alterations to this vision and implementation. Still, the urgency demands attention and the attempt because time is not on our side.
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Dr. Robertson is a health researcher and educator, not a physician. The information provided here is not medical advice, a professional diagnosis, opinion, treatment, or service to you or any other individual. The information provided is for educational and anecdotal purposes only and is not a substitute for medical or professional care. You should not use the information in place of a visit, call consultation, or the advice of your physician or other healthcare providers. Dr. Robertson is not liable or responsible for any advice, course of treatment, diagnosis, or additional information, services, or product you obtain or utilize. IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY, YOU SHOULD IMMEDIATELY CALL 911 OR YOUR PHYSICIAN.
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