In conversation, a friend brought up the concept of ‘Sustained Health Engineering’. Thanks Tommy and NBT!
In my opinion, ‘Sustained Health Engineering’ is a healthcare model that emphasises the patient. The patient who can own their health by considering the factors in their lifestyles and physiology that are known contributors to chronic disease, by seeing how these metrics fit into a systems-based approach to disease, to be able to adjust and tinker their lifestyles to respect their own individual physiology, genetics and epigenetics. An individualised approach to lifestyle medicine, primarily led by that individual (with select help from a clinician)
But Rory, Sustained Health Engineering sounds just like Lifestyle Medicine. Y’know, addressing the wider determinants of disease, sleep, stress, diet and stuff. Why not just call it ‘Lifestyle Medicine’?
Engineers find solutions to problems. The best engineers find the root cause of the problem and provide a long term fix. The rubbish engineers ‘band aid’ the problem with a temporary fix.
Your tap on your sink is leaking. It won’t stop dribbling, even when you tighten it as hard as you can. Conventional medicine would put a bucket underneath it to stop the floor soaking through, but the tap is still dripping. The bucket will overflow eventually, but for now the problem is solved.
Alternatively, you could reverse engineer the problem –
Understand the design of the tap, the mechanism of the washers and valves, the function of the seals. To localize where the problem lies, to address the specific lesion. No need for a bucket, just buy a new washer.
What happens if a problem is approached by a doctor?
A patient comes to their doctor with fatigue, thirstiness and the patient is passing lots of water. Blood results show low HDL, high LDL and the triglycerides are through the roof. The liver enzymes are whacked and GGT is high. Fasting glucose is 9mmol/L and HbA1c is 11.
To the doctor, this looks like a shit storm. The next step is to give a statin, metformin and place the patient on the diabetes pathway of intensifying pharmacological control of blood sugars.
This approach to treatment is to patch over the problem with medication. What this approach fails to consider is the root cause of the problem.
What’s the bucket? Where is the washer? What happens when the bucket spills over?
In this regard, using the term ‘engineering’ is better than using ‘medicine’.
The dependence of Sustained Health Engineering upon the patient completely flips the current healthcare model upon its head. We have a ‘top down’ approach where doctors give directions and prescriptions to their patients. The doctor owns the patients care – regardless of how much communication or information a doctor gives the patient, the majority of decisions of ‘best care’ will be deferred to clinicians and governing guidelines. By avoiding the term ‘medicine’ we escape the paternalistic baggage associated with Western medicine. In Sustained Health Engineering, patients are the ones placing a long term investment into their health. It is ‘bottom up’ medicine, and this is the direction I think medicine should move in. Otherwise, I think practitioners within many fields of medicine should adopt the title of ‘chronic disease management consultant’.
As an aside, I think we could chat about a ground up approach for hours – it is important for multiple reasons that incorporate workload, burden upon the health system including financial costs and demand upon its doctors, however, this blog focuses on the patient’s experience of health – the effectiveness of prevention, diagnosis and treatment. Which is an important place to start.
What do you think? Do you have a better term than ‘Sustained Health Engineering’?