Ignoring the root cause in healthcare

Every book or long form podcast contains at least one gem of information, new perspective, or piece of context that shines new light on an old topic. That’s the opening sentence from my last post: War Good. Trump Bad. But the theme continued when listening to another Joe Rogan podcast (I’m on a Rogan roll). This one was with Chris Williamson.

They were discussing a wide range of topics when Chris dropped this piece of knowledge on me. He said that patients who undergo bariatric surgery have higher rates of suicide post surgery. The reason, he explained, was because obese patients get that way by using food as a coping mechanism for whatever trauma they are trying to deal with. No different than the way an alcoholic drinks, or a drug addict drugs. They are all dealing with the same thing, unaddressed trauma, their substance of choice just differs.

But when patients come out of bariatric surgery, and the size of their stomachs have been greatly reduced, they can no longer eat enough to sedate those depressed or anxious feelings. They can’t eat themselves into a “food coma” and feel ok. So, they turn to self harm. And it turns out, it’s true.

It’s another one of those things that after hearing makes so much sense, but not something I ever thought about before. Bariatric surgery is addressing the symptom of the disease. It’s addressing the weight gain, not the reason the patient gained so much weight in the first place. But the root cause of why they got that way is ignored.

I feel sad when I hear things like this. Because people turn to doctors, hospitals, and clinicians to help them with whatever ailments they face. And it’s the job of the practitioner to figure out what’s really going on, but most of the time they don’t. An obese patient needs to lose weight to save their life and improve their quality of life, but excess weight is not the underlying issue.

And while there are probably bariatric surgeons out there who address the whole problem, or try to by referring their patients to psychotherapy in addition to surgery, most physicians probably don’t. I worked in the system long enough to know how most physicians operate. And it’s not totally their fault.

Incentives are woefully mis-aligned. Surgery makes money, so hospitals and surgeons are incentivized to perform surgery. Spending time with a patient and coaching them to lose weight is not a money maker in the short term, so very few physicians put any real effort into it. 

It’s just another example of the failure of our healthcare system. It’s just another example of how we don’t address the root cause of issues in this country. We just try to cover them up or cut them out. Meanwhile the issue continues to lurk in the darkness waiting to rear its ugly head again.

A system that works for everybody is very badly needed in this country. A total realignment of healthcare’s incentive structures is very badly needed. So many people are suffering and not getting the help they need. Imagine if we had a system that actually worked for everyone.