Rishi Manchanda has worked as a doctor in South Central Los Angeles for a decade, where he’s come to realize: His job isn’t just about treating a patient’s symptoms, but about getting to the root cause of what is making them ill—the “upstream" factors like a poor diet, a stressful job, a lack of fresh air. It’s a powerful call for doctors to pay attention to a patient's life outside the exam room
"In healthcare, we often treat symptoms without addressing the conditions that make you sick in the first place. And there are many reasons for that, but the big three are first, we don't pay for that. In healthcare, we often pay for volume and not value. We pay doctors and hospitals usually for the number of services they provide, but not necessarily on how healthy they make you. That leads to a second phenomenon that I call the "don't ask, don't tell" approach to upstream issues in healthcare. We don't ask about where you live and where you work, because if there's a problem there, we don't know what to tell you. There's this gap between knowing that patients' lives, the context of where they live and work, matters, and the ability to do something about it in the systems in which we work.
If we're all able to do this work, doctors and healthcare systems, payers, and all of us together, we'll realize something about health. Health is not just a personal responsibility or phenomenon. Health is a common good. It comes from our personal investment in knowing that our lives matter, the context of where we live and where we work, eat, and sleep, matter, and that what we do for ourselves, we also should do for those whose living and working conditions again, can be hard, if not harsh. We can all invest in making sure that we improve the allocation of resources upstream, but at the same time work together and show that we can move healthcare upstream. We can improve health where it begins.
Pedar and I talked a bit about this last night and we both acknowledged that you can't change people. The only thing you can do is try and influence their behavior. I hope our healthcare system gets to a place where doctors can say to their patient, "Your living situation is not healthy for you. I want to help you make a change so you can live a better quality of life and here are the resources to help you do that." I hope we can create a healthcare system that can help people feel empowered to make lasting changes and have better health because of it.