Monday, September 21, 2009

Our Most Valuable Assets Are On the Line

An urgent conversation about the state of our health and the disappearance of our GPs  with doctor daniel carlin

CG: We tend to think about our most valuable asset as our investments, our homes, our jobs, but there are far more valuable ones, one we don’t pay enough attention to let alone actively manage and appreciate…until there’s a problem.

DC: Yes, one is our personal health, our physical well being. The other, related one is the vital yet vanishing role and number of our country's primary care doctors.

I work as a medical consultant with some of the world’s wealthiest people. Individuals and families of all kinds, including senior executives. Many of them take smart, active and holistic approaches to managing their financial risks and assets, yet put little priority on their health and health risks.

Surprisingly, they fail to see their own health as a priceless asset, as a key variable in their enjoyment of life. They rarely give it the profound attention it deserves. They’re also challenged – as many of us are – in finding doctors who can help them tend to their health, prevent problems and facilitate decisions. Doctors who’ll talk candidly with them; caringly, and at length.

Of course without good health all other wealth is meaningless. It’s true on a personal level, and it’s true on a national level, meaning the health of our population as a whole.

CG: Is this what led you to a more enlightened approach?

DC: I got into the niche of 24/7 personal doctoring and started
World Clinic because the system was becoming so impersonal; revolving so regressively around procedures and images.

I went completely outside the system; straight to very intelligent and enlightened people and said: you’re an expert on managing your financial assets. I’m an expert on managing physical health. The return on investing in someone like me directly will be greater well being and peace of mind…and likely greater longevity. What’s the value to you of more well being and time for your philanthropic work, family and friends, joys and passions?

A vital part of what I do as their medical advisor and point person is think. I serve as a seasoned guide, quality judge and risk “manager” for whatever’s going on with their health; for any care they’re seeking or receiving from the system.

On the most fundamental level, I help bring their awareness and attention to their greatest source of wealth: their physical well-being.

CG: You’ve said “
locus of control” is a central concept, that impacts pharmaceutical marketing and helps or hinders our personal care.

DC: Yes, and this means who’s making the decisions: who has the control, you or your doctor. This affects everything. Including how drugs are currently marketed by companies, which is
psychographically. From Viagra and Ambien, where marketing messages are direct-to-consumer and all about you being in control, to blood pressure medication where, because of the complexity of the condition, they’re all about your doctor calling the shots (which assumes you have a good doctor to make the right choices for you).

There’s also a strong generational dynamic at work. We have Baby Boomers who feel they’re in charge of their health decisions, and seniors who feel their doctors are or should be in charge.

My first question to a hedge fund owner or rock-and-roll entertainer client is: why did you hire me? My second question is: tell me who’s in charge of your health? I’m absolutely amazed at the answers. Many masters of the universe don’t have a sense of their own mortality: they believe they’re invincible.

Most of us need to do some emotional homework. How do you feel about your health? How invested in well-being are you? Are you empowered, and making confident choices – or do you automatically defer to your physician?

CG: Don’t most physicians help people make decisions?

DC: Sadly not really, because modern medicine is now governed by an almost pervasive fear of litigation. Physicians are reluctant to provide anything beyond basic, objective facts that can be supported in a courtroom. They’re rarely if ever willing to say to a patient is if this was me, this is what I would do

In the specialist-driven world we live in today, we’ve lost the country and town doctor: the family doctor who knew and looked at your big picture. Who had the luxury of a real and honest relationship. Instead we have a predominance of specialists who look at and diagnose and treat you narrowly, without this vital view: without these wider, wiser insights and personal connections.

CG: How and when did we get into this worrisome situation?

DC: Going back to about 1965, the world of medicine was made up of mostly primary care doctors and general surgeons. When science started unlocking the ‘big secrets’ of the human body, the age of specialization began. As a result, internists started becoming obsolete and replaced by field-specific specialists, from cardiologists to neurologists. Advances in technology led to specialist surgeons doing only one, extremely specific kind of surgery.

More and more money started going toward procedures and less and less to office visits. The healthcare system has since favored and now richly rewards the procedurists and technologists; who rarely if ever talk to patients. All of this at the expense of the essential yet much lower paid general practitioners who do the heavy lifting with patients: who spend the time to consult with them, interpret their histories, and point them in helpful directions.

To me, there’s something very wrong with this picture.

CG: What’s happening as primary care doctors disappear, as they throw in the towel?

DC: Their essential value has become more obvious. There’ll be fewer of them to keep us on the right and best path to wellness, diagnose serious illness, be fairly immediate resources to call on with questions, knowledgeable people to tell our story to. And fewer of them out there to listen and care about us.

Technologists and procedurists don’t, can’t play this role. And none of them are engaged or invested in long-term relationships with patients. That’s the nature of the system we have. Specialists even talk about patients as organs or diseases, not as people, which says a lot. I’ve been a doctor for over 25 years, and talk about all of mine by name. I know and relate to their personal stories, to their larger life situations.

Another root problem is how we pay doctors on the basis of 7-minute primary care visits. By the time they say hello, how are you, have a chat, most of that time has elapsed. So there’s no time left for them to think properly. Or, they might quickly scan your information, say here’s the story and see you in six weeks or six months. You the patient are sent out the door unclear or unhappy or both. Even for me, a doctor inside the system, dealing with my own health issues, even I encounter this.

CG: What should we all be asking?

DC: Is there a doctor in the house, a doctor out there who truly cares about me?

CG: What’s our greater social responsibility?

DC: We need to support paying doctors properly, to do the critical thinking that gives a clear and meaningful context for patients and their medical issues. Likewise, give doctors enough time to connect with their patients in order to help them preventively, proactively. All this would go a long way to stopping or slowing the endless, wasteful merry-go-round of consult/image/lab-test/procedure, where too few are doing this thinking for too little money while too many down the line are getting richly and overly paid to do a slice of disembodied informational work.

At the same time, we have to stop compromising our personal health with poor behavior, behavior we flat out know is unhealthy.

CG: How do we keep physically healthy, individually and as a population?

DC: There’s the fledgling concierge model, where you pay a small retainer so your provider can make a decent living. In return they care for and about you. You might pay $80 a month for a doctor like this. Well I’d take that deal, it’s a good one; especially when you look at how many of us pay $1,000+ a month for health insurance with large deductibles.

Staying healthier personally? It’s not rocket science. There are basics: your weight, your blood pressure – and your general attitude of happiness and contentment with life – which I believe is the most important component of our well being. If you’re very heavy, or your pressure isn’t well managed, or you’re depressed, it’s straightforward: you’re not healthy.

Staying healthier as a country? Imagine if we had an earthquake every year that cost the U.S. 17% of its GNP. Wouldn’t we be spending money on preventing earthquakes? And moving people out of earthquake zones? Of course. Yet we have a similar situation: collectively epic medical earthquakes, from heart disease and lung cancer to stroke, most of them self-inflicted. These “man-made” disasters cost our country a massive amount of national resources year after year after year. Yet there’s no seriously productive spending on preventing them or on changing people’s unhealthy behaviors.

CG: How does consciousness change in desired directions?

DC: The national consciousness is starting to change. At the end of the day, though, money and political interest will shape the outcome.

What we need to raise first is our own consciousness. To realize there’s no healthcare coming to save our bacon. Most facilities across the country are overburdened, and are hard pressed to deliver a high caliber of care to everyone. We must also be acutely aware that good general and family practitioners, internists and pediatricians are an endangered species, a vanishing species.

Here are three rules of personal responsibility to live by:

Rule one. Make a commitment to wellness, and avoid getting sick if you can help it.

Rule two. Find a way to acknowledge your doctor for caring. Don’t take it for granted. They made a decision to care on a professional basis with no expectation of reward. So be the thoughtful, appreciative kind of person they look forward to seeing and helping.

Rule three. Vote, make your voice heard, be part of the political process, to save the good primary care doctors from becoming extinct or demoralized. It’s in your best interest.

CG: What kind of primary care doctors should all of us look for?

DC: GPs who are profoundly competent, understand the human condition, and can connect clearly and quickly with you as a patient. An individual who’s emotionally-wired and committed to care, and will go the extra mile as the rule not the exception.

Though diminishing in number, GPs like this do exist.

CG: What do you see as our biggest opportunity?

DC: Making patients an active, central part of their healthcare experiences. The key variable is not the doctor and not the medication or the test, it’s you, the patient. Each one of us needs to be actively involved with our well being. To be taking charge. To be wisely managing our greatest asset, our health – and getting a good, caring, committed physician to manage and enhance it with us.

CG: Dan, many thanks.

Colin Goedecke is a senior marketing writer, messaging strategist and interviewer, with a 23-year history helping leading and emerging companies worldwide platform and tell their stories. Our Most Valuable Asset is On the Line is the 18th in a series of thought pieces, to help us think, act and communicate in wiser ways. Others can be found at

Daniel Carlin is a 25-year-long physician, clinician and thought leader in medical change. He’s a former US Naval officer, and founder and CEO of World Clinic,, a unique, global, 24/7 medical and telemedical practice serving a select group of senior executives and wealthy individuals and families.

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