Hello, health enthusiasts, and welcome to Rev Up Health, your go-to podcast for all things wellness. I'm Dr. Mark Hechler, and I'm Tandi Hechler. Together we're here to fuel your health journey with the best of functional medicine and holistic well-being. Each episode, we'll dive deep into topics that matter to your health, bringing you the latest insights, research, and inspiring stories. Whether you're on a quest for vibrant health or just looking for daily health tips, we've got you covered. So let's embark on this journey together and transform the way you live. So, Tandi, what's on our wellness radar for today?
Hello, and welcome again to the Rev Up Health Podcast. I'm Tandi, and I'm Dr. Mark. Today we wanted to visit a little bit about a comment we got on one of our social media posts recently. It was a great one, and it talked about accountability being a really important part of the healthcare equation. That just really stood out to me.
Two Healthcare Equations
There are actually more than one healthcare equation, and I want to talk about both of them separately today. The first is the healthcare equation meaning all of the different pillars of health. We have physical health, mental health, emotional health — which kind of goes with mental health — financial health, social health, sexual health, and spiritual health. All of these things are a part of a person, and whenever one is a little out of balance, it's affecting the other areas. That's one piece of the healthcare equation.
The second piece is how much we put on our providers versus how much we put on ourselves. I can't tell you how many times I'll walk into a room — I always start by introducing myself and saying, "Hey, how can I help you today?" — and the first thing out of a patient's mouth is, "I don't know, you're the doctor." That tells me they're wanting a quick fix; they want me to understand everything and give them a simple medication or something to just take care of the problem and make it go away. But that doesn't give them accountability for what they're going to do for themselves, and how they're going to carry through with whatever suggestions or advice I may have for them.
Patient Compliance and Accountability
I think something that comes up quite a bit is patient compliance. In healthcare today, providers are held to a pretty high standard, and patient compliance isn't really taken into consideration. A provider can give all of the information and good advice, but if the patient doesn't take that home and act on it, it's not really the fault of the provider — yet they get dinged from a quality measure for it.
A lot of the physicians out there can probably answer to this too: you may tell patients something, but the majority of those patients — probably 80%, or even 80 to 90% — won't follow through with everything you want them to do, because they just don't want to change their lifestyle. It cramps what they already do, what they've been doing for years. Well, how's that done for you? You're still metabolically unhealthy. So I try to emphasize that I'm a small part of this equation. We are a small part, as providers, of the equation for the health of a patient. I always suggest that they are 80 to 90% of the equation of getting themselves back to health, and we are only 10 to 20%. We have answers, we have suggestions, and we have ways a person can reach a healthy state, but it is totally up to the patient to fulfill that and carry through. Truthfully, most of the time they don't need me, or us, or anyone from a healthcare standpoint to tell them the right things to do — they already know the right things to do, they just don't carry through sometimes. And it's hard to do.
How the System Took Away Empowerment
I would say that our healthcare system has really taken that empowerment away from patients, because there's all of this scientific information that says follow the science, do these things, go see this specialist, and no, you have to see this other specialist for something else. We've created a situation where we've taken the power away from the patient and enabled them to feel like your doctor can fix everything you need fixed with a simple pill, or a simple shot, or a round of antibiotics that takes care of it. But it doesn't, if you continue down your same lifestyle pathway — whether you're eating processed foods or not putting forth the exercise activity. These types of things continue to plague you with chronic disease.
I guess what I'm saying is that we've kind of set patients up for this a little bit. That's true to some extent — medicine and healthcare have set patients up for this somewhat. But as a patient, you're also seeking the advice and knowledge of that provider to give you the information so you can correct your problems. So it's still on the provider to be able to give them that information so they can actually heal themselves.
Listening to Your Own Body
I think that is very true. Another piece is remembering that we can listen to our own body. We really are very in tune, if we take the time to listen, and we can figure out a lot of things for ourselves. That's one thing I really love about nurse coaching — a lot of what I do as a nurse coach is help patients rekindle that connection with intuition and listening to their own body, and guide them on their path. Not necessarily direct them, but be there as a cohort to help them navigate their own problems.
Absolutely. It is 100% a collaboration; it is not one-sided. As patients, we know what the most important things are to us, and once we identify that starting place, it's going to continue to funnel into the other areas of our health.
Instant Gratification and "Dr. Google"
We also live in a world of instant gratification. Everybody's got a cell phone, a computer, internet — not like the old days when you had to go to the library and look up the encyclopedias, or go through the card files. That's old school, and some of you know what I'm talking about. But now, with an instant phone at your fingertips, in your back pocket constantly, your thumbs can do the walking for you and you can find anything you want. That's spilling over into everything — whether you're in healthcare, or going to Walmart, or going to the auto parts store — you want it, you know where to find it, and you want to get it now.
That can actually be a double-edged sword sometimes, as far as empowering patients with the information of Google, and "Dr. Google," so to speak. You have patients come to you and say, "Here are the things I've diagnosed myself with, and this is why." That's exactly right — I have so many patients come in and say, "Well, I've got Ménière's disease," or "I've got this problem or that problem." Okay, well, what are your symptoms? "Well, they gave me this for that." Okay, why did you get an antibiotic, or why did you get this medication for it? I don't really want to know what they got — I want to know what their symptoms are.
When Patients Aren't Heard
That's really an issue too, from a patient standpoint — patients aren't heard. You go to the doctor or a healthcare provider trying to get an answer, but they don't always listen. If they would just sit down and listen to you, 90% of the time I can diagnose a patient without even touching them or listening to their heart or lungs, or looking in their ears. You just listen to the patient and they're going to tell you what's wrong, and then you can literally make a diagnosis sitting in a chair listening to them. The majority of the time — 90% of the time — I sit down to talk to the patient and I already know what's going on as they're telling me their problems and symptoms, and then with further questions, all I do is confirm what I'd already thought the situation was.
The Insurance Company's Role
If you look at the healthcare equation, you've got the patient, the provider, and then you've got the insurance company. The insurance company, unfortunately, has control over how the money is used in healthcare, so they also have a big part in that. There are multiple times where we may suggest a surgical procedure, or a grouping of procedures or tests that need to be done, and yet the insurance company may legitimately review it — or just simply pull it out of a hat and deny that test or one of those procedures. So that's also an important part of the equation.
You're right. Even to draw a vitamin D level, you have to have a certain ICD-10 code to qualify the patient for vitamin D — which most of us are deficient in, over 80%. And even testosterone levels: if you're not under 300, they don't even consider treatment options for you unless you're at least under a 300 level. So in the current state, a lot of people have the perception that the provider is 80 to 90%. I don't think most patients know how much insurance plays into their equation — they just hope that everything's paid for. Heavy on the provider, less on the patient, is kind of the mindset we've fallen into.
But the way we're looking at healthcare is more — I would like to take insurance completely out of the equation. Wouldn't it be a great world if we could do that? I don't think we have a good solution there, and I don't think that's going to happen very soon.
What Is Patient Compliance?
What is compliance? What's the definition of patient compliance? It's defined as the degree of adherence of a patient to a prescribed diet or treatment — whether or not the patient returns for reexamination and follow-up treatment. In medicine, compliance describes the degree to which a patient correctly follows their advice. Compliance runs right along there with accountability — I think those are kind of interchangeable, the patient being accountable for their end.
So what would you put? We already talked about this a little; you spelled it out. You really think the provider is more like 10 to 20%, and the patient is ultimately 80 to 90% of the healthcare equation — whether it's following the correct diet, taking your medications for your blood pressure, or getting your nutrition right. We've got to get away from that word "diet"; it's a bad four-letter word — I've said that multiple times, you've heard me rant on social media. But nutrition is really key, and unfortunately that's a whole other podcast too. With big food and pharma being a big downward influence, we'll cross that bridge on another podcast, but that's a big influence on how patients eat and what they consume, and likewise, down the road, it deals with what kind of chronic disease they're going to develop.
The Holistic Picture — Every Pillar Bleeds Into the Others
The other piece of your healthcare equation is more about looking at that holistic part of a patient — the entire body and all the systems influencing your overall health — and remembering that every piece bleeds into the others. If your financial health isn't great, then you may not have the means to get the nutrition you need, or have access to a workout facility, or even the physical ability to get to the workout facility, or get to the areas where you can exercise or go outside to walk.
And the social piece — this is kind of where we mesh into the other equation, where accountability comes in. It is so much easier to be accountable and compliant when you're able to surround yourself with people who are like-minded, have the same goals, and are supportive. A good supportive family is a huge deal. If you're trying to quit smoking and your spouse isn't interested in that, it's really hard to stop. Same way with eating and nutrition — if somebody wants to go out and get pizza, well, okay, I guess we'll have pizza tonight. You may have other things in mind, but without a good social network, it's difficult to keep motivated.
Where Coaching and This Kind of Practice Help
That's something where, luckily, as a coach, you can provide that accountability. In this kind of practice we're working in, there's a little more time for us as providers to help along with that accountability — more so than your primary care, who's seeing patients in and out every 10 minutes and doesn't really have the bandwidth to provide it. We can send an email reminder of, "Hey, don't forget about this," or actually say, "Send me your blood pressure readings next week, and I'm going to look at it and we'll talk about it." Or a nutrition plan — "Send me what you eat each day, your breakfast, lunch, and dinner, and we're going to go over that and see if we can't help your type 2 diabetes improve a little bit."
It's a difficult problem. I feel like we should use one of those bells we have around here, and every time I say "diet," ding it. I'll give you a dollar every time I do it — you could be good. It's a difficult situation to try to figure out how best, as a provider, to have patients become more accountable. And yes, there's accountability on a provider to provide that information, that prescription, or that game plan, and make sure the patient follows through. A lot of times you can suggest it, but "okay, I'll see you, if you have any problems let me know" — that's a difficult thing to do.
The Fear of Holding People Accountable
I also think in today's age, where everyone is reviewable, sometimes as a provider it's hard to want to say the hard things and hold people accountable, for fear of a bad review. So it's definitely a time of transition where we can explore what this new landscape looks like in healthcare.
I think if we can all come to an agreement — and, unfortunately, backing up a little here, the insurance arena we work and live in is also a pretty significant driving force in what we say, what we suggest, and how that's followed through. Some of these things are, "Well, it's not covered. I'd love for you to do this, or A or B, but it's not covered on your insurance," or "this medication is not covered on your insurance" — or it used to be, and now it's not. Those types of things influence behavior and outcomes too.
You may have just opened Pandora's box there, because that's actually a huge piece of patient compliance — patients rationing their insulin because they're afraid they're going to run out, or not being able to take a medication anymore because they can't afford it. Insulin used to be very expensive; it's coming down, but it's still pricey, and it's not like you have an option. You don't have an alternative if you're a type 1 diabetic — you have got to take it. Type 2 diabetics have other options. And then there's the whole weight-loss ballgame, which we'll cross in another podcast.
Our Goal: A Better Advocate for the Patient
Ultimately, there are a couple of different ways to look at the healthcare equations, and from our perspective, we're looking at a way we can help and be a better advocate and supporter of the patient, so they can truly be 80 to 90% of the healthcare equation, and we can fill in our 10 to 20%. It's kind of on us to not prescribe the most expensive medication out there, or the most expensive test, and to try to treat the patient instead of making the insurance company happy — for instance, ordering the test they'll pay for, when not every test is going to tell you the answer you want.
That's another way to take into consideration the whole person and that piece of the healthcare equation — really taking the time to know not only the physical status, but the mental and emotional status, the social, the spiritual — the whole picture. That whole picture also needs to be used when providers are making recommendations.
So that's our goal. Our goal is to help people navigate through their health needs — listen to the patient and try to make a doable path. We can't throw everything at somebody at one time and expect them to get it done; it has to be taken in small bites. You can't sprint through a marathon — you've got to take it in small sections. If the patient and the provider are on the same page, it's a whole lot easier, and they're going to have a lot better compliance in the long run.
That was a good visit. Thanks for joining us. If you have any questions or comments and want to reach out, you can find us at revelationhealthandwellbeing.com, or keep listening to the podcast. We do this out of purely educational support, and just love to provide free educational information for folks to make better health choices. Thanks for joining, and have a great day.
Thank you for tuning in to another episode of Rev Up Health. We hope you're leaving with some valuable insights to supercharge your health journey. Don't forget to follow or subscribe to Rev Up Health wherever you listen to your podcasts, and if you enjoyed today's episode, please leave us a rating and review. Have a topic you want us to explore? Reach out to us on our social media channels — we love hearing from our wellness community. Until next time, keep thriving, and remember: your journey to health is a journey to a better you. Stay well, and we'll connect with you again soon. This is Tandi, and this is Dr. Mark, signing off from Rev Up Health. Take care.
The information provided in this podcast is for educational purposes only and is not intended as medical advice. The content is designed to support, not replace, the relationship that exists between a patient and their healthcare provider. Always consult with a qualified healthcare professional before making any changes to your healthcare regimen, including diet, exercise, or treatment plans. The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the official policy or position of Revelation Health and Wellbeing.