Building a Model of Preventative Health Care
Most people will agree that preventing a problem before it arises is a good idea. Most people will also agree that the Canadian health care system already has a problem: too many aging, sick and ailing people and not enough doctors, nurses and hospital beds to accommodate them in a timely manner. This problem affects all of us, some more than others, but it affects all of us. Blaming the government is not the solution, taking on personal accountability for your own health is. The government and the current medical system is so tied down by trying to deal with the sick, injured and aging that it will have trouble ever catching up to the point where it can legitimately focus on being a preventative system. Even if it did, preventative health requires by-in from the individual and the general population to assertively educate and take care of oneself. The support system and infrastructure is there, but most people don’t know how or when to utilize it to help themselves in a preventative manner.
It is an accepted and studied fact that exercise and mobility have positive effects on physical and mental health, but how do we use this vague statement to help our well-being? The general population is a busy group that unfortunately will chose convenience over health most of the time. So how do we make exercise and mobility convenient? The answer is to educate people on how to use their bodies efficiently so time is not the excuse for poor health. Basic knowledge of injury and healing combined with education on postures for sitting, standing, walking and lifting could prevent countless pains, injuries, disabilities and trips to the doctor’s office. As parents we closely monitor our children’s movement milestones in the first two years, but once they are able to sit, stand, walk and run we do very little to make sure they are doing it all properly; mainly because we all take movement for granted. People are quick to blame their physical attributes on genetics, but a big part of the reason children end up with similar posture and flexibility to their parents is due to learned movement patterns. So how do we prevent our children from having to experience the same physical ailments we have? Teach them about their physical bodies at a young age and have professionals there along the way to help.
Family physicians are the gate keepers of our current medical system, a system under strain, reliant on medications and costly surgeries. Western medicine has accumulated a vast amount of knowledge to the point our physicians are required to specialize in a certain field so that we can adequately use all that we collectively know. Our medical students are taught a little bit about everything in school and then focus on a specialty where they learn a lot about something very specific until they become compartmentalized into a small box. Family physicians are the generalists and the first point of contact for the population regarding matters of general health. People have a lot of faith that their doctor will know what is wrong with them and will be able to help, or will send them to a specialist for another opinion. The problem is that the average family physician does not have a very extensive knowledge of functional physical health dealing with musculoskeletal pain and injury. It is a short unit in medical school that gets discussed in theory, but gets brushed over by most students because the level of evidence for most forms of conservative treatment are low. In practice, the average doctor visit is only 10-15minutes long consisting primarily of a subjective history looking for red flags and a limited objective assessment due partly to lack of time and partly to lack of knowledge. The ability of physicians to prescribe drugs to deal with immediate pain and to order diagnostic tests like X-Rays and MRIs that take a snap shot in time of a person’s skeleton and soft tissue gives them a false sense that they know what is or isn’t wrong with a person. The pressure from the patient for immediate pain relief, the reliance on “diagnostic tests” and the time crunch of short visits never gives the family physician the opportunity to adequately learn about the true origins of pain and how it should be dealt with.
Musculoskeletal pain is a multi-factorial issue that is very common and is responsible for a huge number of doctor visits each year. Conservative treatment for musculoskeletal pain and injury is challenging to scientifically study with the levels of evidence drug trials attain because there are so many variables to control. Pains that get lumped into the generic categories of “sprains & strains” or “soft tissue injury” could be coming from the muscular system, nervous system, or visceral system and are strongly affected by emotion, attitude, and body awareness. It is an interconnected system that should not be completely compartmentalized with a need to give every pain a specific diagnosis. This practice of having to put a name on something may help the people with very straight forward injuries, but ends up leaving all the people that do not improve along a “normal” time line to struggle with chronic problems, question themselves and battle with insurance companies that think they are malingering.
Chronic pain affects a person’s mental and physical health. If you take a survey of a thousand people over the age of 30, you will find that 90% of them experience some sort of pain, tightness or stiffness on a regular basis (my informal stats). Most people will blame it on genetics or age and just resign themselves to living with it. There can be physical issues that create back pain, abdominal pain, heart burn, shortness of breath, chest pain and much more. The general population’s lack of knowledge, and the current medical system that most of it relies on has created a dangerous trend of dependence. A system of empowerment through knowledge and awareness needs to be created; knowledge of how our bodies work, awareness of how to use them and a blending of “Western Medicine” with all the complimentary services that currently exist. This system needs to educate our high school students, teachers, parents, therapists and physicians. It should be a system that draws primarily from clinical knowledge that is backed by sound scientific principal, not a system that tries to extrapolate clinical practice from vague conclusions of scientific research. The focus needs to be on the root cause of problems instead of giving in to addressing the symptoms.
Physiotherapy in Canada is a healthcare discipline with a very broad scope of practice. Physiotherapists work with people of all ages and abilities to help maximize function and mobility for physical health. Therapists draw from all other disciplines to create a large tool belt to help people. These include medicine, psychology, osteopathy, massage, chiropractic, kinesiology, acupuncture, neural and cardio-respiratory rehabilitation. Working with people in a hands-on way on a day-today and week-to-week basis gives physiotherapists the best framework to educate people on their physical health. This is why an interactive educational tool built around physical therapy principle could be the best way to shift public dependence from the medical system to an educational system.
The wide spread dissemination of knowledge has become very simple and efficient in the last 10 years due primarily to the internet. Health related queries are among the most popular searches on the internet today. The problem is there is so much information out there that people just start looking for their symptoms and read whatever comes up on the first page of Google. Most people will learn something about a specific pain or injury with no context of how or why they may be experiencing it. The best way to create a preventative healthcare system is first to make sure that the people that want to assertively help themselves have the tools to be able to do it properly. Countless people have been told that “stand up straight, shoulders back and down” is good posture and to “lift with your knees, not with your back” is the best way to pick something up, but most people have no idea how to do that properly. People have different body types and a piece of advice that may be the best thing for one person may be the worst thing for another. The personal training industry is a perfect example. It is an unregulated private industry full of inexperienced trainers that people turn to for health and fitness. The social perception is that you need to do more exercise and work on your “core” to stay fit. Some people end up with great results while others end up in pain and unsure of how they can stay active without hurting themselves. People need to know that there is not always a need to do more, but there is a need to do things properly for their own body. They need to stop listening to people telling them what to do and start asking why and how.
Knowledge and facts are useless unless we have a context in which to use them. The goal of this website is to create an online tool for the general public and to be used in educational systems for high school students, physiotherapy students and medical students. It will have resources for teachers and healthcare professionals to help their students and patients create a context for their physical health. It will be open to the general public interested in educating themselves, but will be structured for formal education. It will disseminate knowledge about physical health in a functional and practical way that relates to activities of daily living throughout the general population and to the healthcare providers. It will strive to create a healthier, more aware population which should translate into less doctors visits, less chronic conditions, less medications, less surgeries and less strain on the medical system. The aging population will be able to derive the most immediate benefit by means of helping them with their already deteriorating physical health, but the next generation will profit from knowledge and the ability to prevent acute conditions from becoming chronic. The end result should provide a more informed population that utilizes the allied health services like physiotherapy for musculoskeletal issues and frees up the medical system to deal with people who are sick or injured.