[phobosanomaly]

Maybe this just isn't the type of problem we should be looking towards a physician to address? They spend at least seven years in school learning to handle certain types of problems that can be addressed with certain types of solutions.

Perhaps this type of thing (lifestyle issues) is more in the wheelhouse of a dietician or a lifestyle coach who has a different type of training.

If you have sepsis, a dietician probably wouldn't be the safest bet. If you have lifestyle issues with diet and exercise, maybe a physician wouldn't be the safest bet.

[sebmellen]

You raise a good point, and I don’t disagree.

This article is interesting to me because it portrays a version of medicine which treats the patient as an integrated unit.

I think a physician who can interrogate issues more deeply in addition to treating symptoms is invaluable. Maybe someone’s weight is not just a function of their lifestyle or diet, but is also due to undiagnosed, low-level hypothyroidism, for example. I don’t know that a dietician can be expected to have the knowledge and expertise to treat issues like this. Who knows, with the rise of smart medicine we might be able to replicate such a care team through technology.

Also, unfortunately, quality of treatment is in large part a function of time. And in most countries, the level of medical attention one gets is very dependent on how much they can afford. I mean, even in places like Germany that have socialized medicine, the privately insured get better care, more time with their doctors, less time to schedule an appointment, etc.

Knowing that, this might be an insoluble problem until we automate the checklist-style medicine with chatbots and ML, and then reserve doctors for the tricky cases where DDx falters.

[phobosanomaly]

> care team

You used this phrase, and I like it.

I see this as the core of the problem, and I might just be re-phrasing what you are saying.

I risk veering off into politics here, and I don't really want to, but I do think that the profit-centered healthcare system in the United States creates this separation of people who should really be consolidated into a single team. There should be a team of people working together: Dieticians, physicians, etc.

But, in my experience, everything is siloed pretty bad. Physicians work for one company, the dieticians work for another. Everybody is divorced from one-another. Nobody is part of a consolidated team.

Ideally, you would have both a PCP, and a dietician that you could consult, both of whom are part of a team, share the same medical records system, talk to each other over lunch, etc.

Let the doctors do the doctor part. Let the dieticians do the dietician part. Let them both work together for the benefit of the patient. But, integrate them into the same system.