The Future Of Health Care: Health Gurus Or Health Mentors?

In a previous article, I presented four reasons to reject palpation-based models of care. This is no longer an issue of evidence - or lack thereof. There is plenty of research to debate not only the reliability and validity of palpation-based approaches to care, but also passive approaches to care in general. If you have a passive treatment approach, then the patient runs the risk of becoming dependent upon the care of the health guru in order to attain a resolution of their problem.

Sadly, many of the assessment and treatment approaches found in the current market place are exactly that – palpation-based and passive in nature.

What is truly at stake in all of this is far more elemental. It is the issue of perception – of the role of the clinician in the care of the patient. Is it as a health guru … fixer and healer? – or as a health mentor … problem solver, investigator, teacher, coach,  and educator? The future of effective and optimal health care requires a reality check. The solutions lie in the perceptions of the clinicians, the educators, and the consumers themselves.

The standard refrain from the health guru is something along the lines of “if you come to me, I can fix/cure/heal your problem”. For the clinician trying to learn from this same guru, the refrain becomes that of “if you learn from me, and if you can devote the time and dedication (and dollars) to the process, you might aspire to learn what I know”. This happens all too frequently with palpation-based models that focus on the “refined skills of touch”. Of course, you’ll be told that there are “lots of studies” that support their palpation-based methodologies. The reality tends more towards a case study or two published in a less-than-reputable journal (if that).

I think the health care world has seen their fair share of health gurus over the past three or four decades.

But if there is poor reliability, and subsequently questionable validity, then you are essentially selecting a random treatment intervention and hoping it works. I would like to think we have better options available to us than randomly selecting a treatment, especially if we, as clinicians, can agree on the diagnosis or behavior of the system mechanically or physiologically with more reliable methods of assessment.

The current “acceptable community standard” (be it optimal or otherwise) and the traditional role of the clinician has focused on being a fixer, a healer, a guru that has all the answers. Here’s an idea – toss aside the mentality of “I want to be the fixer”, and redirect the efforts towards true patient-centered care. The long-term challenge is to envision ourselves as mentors, not fixers. Until we actively address the perceptions of those in clinical practice – regarding their role with patients at its most elemental level – this issue will never change. 

Maybe we could start by changing the educational programs from the very start. Physical therapists and chiropractors are happy to put their hands in the air and talk about “evidence-based medicine” yet this evidence is being flatly ignored by these professions and the educational programs that are involved. It is then considered acceptable to continue to teach these things – though the treatments based on these evaluative techniques have little to no scientific support. It was rampant in 1997, 14 years ago – and little has changed with educational programs over the years. Educators can no longer be hypocritical by promoting evidence and then ignoring that same evidence in their curricula.

Educational programs could focus on clinical reasoning skills – or, simply put, learning how to think. They could emphasize the well-established effects of exercise and mechanical loading on tissue repair and remodeling. These concepts are well-documented in the cellular physiology and sport sciences literature. If we simply build a foundation of care on clinical reasoning skills and reliable and valid assessment techniques that focus on understanding the behavior of the skeletal system when under mechanical loading, we would be light years ahead of our currently accepted community standards of care.

This could then lead to systemic change for consumers. An approach based on competent self care would be independence-oriented, self-care oriented, and outcome driven – all factors that I would suggest are imperative for true patient-centered care in any medical system, regardless of the reimbursement structure.

When we have this, you’ll find far fewer health gurus making a living off of their “skills” and their ability to foster belief (and dependence) in the patient. The future of health care and it’s economic and treatment successes will depend on shifting the role towards health mentors and true patient-centered care.

Photo credits: alasis