For a lot of people suffering from chronic conditions like hypertension, diabetes and arthritis, it seems like their illness actually gets worse over time despite frequent medical consultations and drug prescriptions. Why exactly does it seem like people with these conditions are somehow being kept from getting well? In our interview with Dr. Kevin Cuccaro, an anesthesiologist and pain specialist, he revealed why he thinks this is so.
In Dr. Cuccaro’s personal experience in his clinical practice, he noted how his chronic patients weren’t getting well despite all of his intensive training. In fact, he saw the same thing with other doctors including those who trained under him. Frustrated, he sought to find the reasons for this.
In his personal view, a doctor should think “like a dentist,” as he likes to put it, and try to “work themselves out of a job,” meaning they should find a way to treat a patient so that they don’t need to come back. Patients should lead healthy lives and only come back if there is an acute, serious problem. But what has been happening in medical practice in general is that a lot of the current medications are not actually effective for what they are being prescribed for. Dr. Cuccaro says that the evidence usually points to a worse outcome when these drugs are used for chronic conditions.
Individuals with chronic diseases use lot of medication. In the US, around 50 percent of the population use at least one prescription drug for maintenance for a chronic illness. Roughly 20 percent use 5 drugs or more. Most of these drugs are for treating symptoms caused by an underlying illness. This means that they are being prescribed solely for treating the symptom and not the actual cause of the disease. There is no endpoint to the medical therapy being practiced because of the neglect for treating the underlying cause.
The same thing can be seen when talking about pain and physical injury. If a person comes in with shoulder pain, the main objective should be to assess why he or she is feeling that pain and then educate them on how they can overcome their injury. If it is due to a poor sleeping position or strenuous activity, then they can be advised appropriately. Medication should only be taken for a limited period of time. This is possible if the cause of the shoulder pain is investigated and treated properly. You are now treating the cause instead of just the symptom.
Instead, Dr. Cuccaro says that doctors and therapists promote people’s dependency on medication. Their patients adapt a way of thinking where their illness can only be managed through frequent consultations and medical prescriptions. So instead of engaging actively in therapy, they become passive and dependent, as if they are helpless without medication. They get trapped in this cycle.
It is vital to note that most chronic diseases are due to behavior and lifestyle choices. Eating wrong, not exercising, being in a bad environment, smoking, drug use, being around toxic people and not handling stress well are all factors that contribute to the development of chronic diseases. However, doctors and therapists find it easier to just prescribe medication without paying attention to the issues that cause or propagate the illness in the first place. Patients then become dependent on these medications.
Dr. Cuccaro says that this type of practice in medicine is just “like slapping a band aid on a cut when it actually needs to be stitched.” This results in the symptoms actually getting worse over time, leading to the prescription of higher doses or additional prescriptions, perhaps with stronger drugs. Thus, the cycle of dependency on medication is perpetuated. Until doctors and therapists realize and put into practice that chronic diseases can be better managed by promoting lifestyle and behavioral changes, instead of solely relying on medication therapy, patients will continue to be dependent on medication for a long time.
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