Wondering what the 5000 hours are?  Roughly: the amount of waking time per year that you are responsible for your own health and well-being.

Scary thought, right?

 (photo by Robbert Van Der Steeg used under creative commons license) 

The article referenced here from the New England Journal of Medicine is about how to increase patient compliance when taking medications – which may or may not be of any interest to you.  However, the issue of compliance (for anything: exercises, herbs, diet…etc) is something that is a huge part of healthcare, and wellness in general and is THE major roadblock in people taking care of themselves. This article got me thinking about some issues that are pretty near and dear to my heart – like that of reactive vs preventative medicine.  As a healthcare provider my time with you is so limited compared to the rest of the time in your life – so how do I, as a provider, give you the tools and desire to change your lifestyle/behavior/diet in such a way that it improves your overall health and well-being?

The dominant form of health care financing in the United States supports a reactive, visit-based model in which patients are seen when they become ill, typically during hospitalizations and at outpatient visits. That care model falls short not just because it is expensive and often fails to proactively improve health, but also because so much of health is explained by individual behaviors, most of which occur outside health care encounters. Indeed, even patients with chronic illness might spend only a few hours a year with a doctor or nurse, but they spend 5000 waking hours each year engaged in everything else — including deciding whether to take prescribed medications or follow other medical advice, deciding what to eat and drink and whether to smoke, and making other choices about activities that can profoundly affect their health.
-via Automated Hovering in Health Care — Watching Over the 5000 Hours — NEJM.  [emphasis mine]

If you’ve never heard my thoughts on the current healthcare system (lucky you), one of my main gripes as a healthcare provider is the above, exactly.  The huge dependence on reactive medicine (and the financial reward for this, but that’s a whole other topic for another time).  Reactive medicine is necessary, yes (there are traumas and things in this world that no amount of prevention can prevent) – but largely the burden on our healthcare system is due to mostly preventable chronic diseases that could probably be avoided in the first place, or could be managed in such a way that expensive and frequent complications do not occur.  So then, why is preventative medicine not our focus?  So much of our research time, dollars and energy are spent on fixing something that’s already broken – don’t get me wrong, I do think we should certainly invest in reactive medicine  –but why isn’t our focus on preventing/minimizing the potential for these big, pricey problems such that the need for reactive medicine (which by nature is often too late and too expensive) LESS?

The second development is our deepening understanding of behavioral economics and the reality that although most people want better health and typically know what it would take to achieve it, the desires, distractions, and urgencies of the moment often get in the way of pursuing what’s in their own long-term self-interest.
–via Automated Hovering in Health Care — Watching Over the 5000 Hours — NEJM. [emphasis mine]

And there you have it – the trouble with prevention.  The difficulty with a paradigm shift to preventative  medicine is many-fold: for one, prevention does not have the sex-appeal of  “a cure” – it is not exciting and dramatic – it takes patience and diligence and putting aside immediate gratification for the big picture benefit. Whereas reactive medicine is so much easier to wrap our heads around (I got hurt/sick – now I have surgery/medicine to fix it).   For another, with preventative medicine a majority of the burden of change falls on us as patients – we are responsible and accountable for our own well-being, and this would require a mindset change (not to mention real effort) from our largely “magic-bullet/take a pill/ cure” loving society.  

But wait, there’s more!