Over the years, I have written many short articles on a variety of healthcare topics. Most were written as a column in the behavioral health provider publication of Blue Cross of Rhode Island while I was Associate Medical Director for Behavioral Health from 2000 to 2012. I am going to upload many of them are as timely and relevant today as they were when written...a sad commentary on the state of healthcare in America.
A Minute With Dr Hancur: The SOURCE, Summer 2004: "Behavior Change"
It seems to be an almost daily occurrence that there is a newspaper article or television news report decrying the state of health care in the United States. Whether insurer, provider, or patient, everyone is trying to get the most out of their healthcare dollar. As we consider ways to reduce healthcare costs, an important first step, in my opinion, is to shift our collective attention away from symptoms as the primary target for treatment and toward a focus on behavior change.
As behavioral health providers, we should welcome such a change in focus as an important support for a work with patients. Facts such as 30% of asthmatic smoke cigarettes or 90% of adult onset diabetes is controllable by diet alone make a compelling case for behavior change as the true treatment for many conditions. Medication, as a standalone treatment without concurrent change in behavior, cannot produce health. Rather, the resulting reduction is symptomatology only serves to hide the evidence that a problem exists.
True health is defined by the absence of a problem, not by the absence or reduction in symptoms. This is never more true than when pain is the primary symptom. The example of the football running back with an injured knee comes to mind. Injection of cortisone may reduce the swelling and dull the pain so that the player may play, but the knee is not repaired and further injury is the probable result of such "treatment". As affective states, anxiety and depression are really types of pain. Treatments that only reduce the patient's ability to feel them without resolving their cause run the same risks. Modification of behavior, along with the symptom-reducing effects of medications, is a more complete treatment, in my opinion. With management problems like diabetes, hypertension, and asthma, it is easy to see the benefits of focusing increased attention on changing behavior because the proximate causes e.g. carbohydrates and cigarettes are so obvious. Headache, panic attacks, gastric upset and the like, often require an analytical investigation to determine the causative or precipitating conditions. Once identified, change in interaction or approach within those conditions is the optimal treatment.
If we begin to think of antidepressants and anti-anxiety drugs as "pain relievers" rather than as antibiotics killing bacteria, we can more easily see that the true job of treatment is behavior change. Reducing pain may enable or facilitate change, but it is not in itself a resolution of the underlying problem. Behavior change is the necessary, even critical, component in achieving true health. Medications or procedures have their place in healthcare delivery but rarely are they sufficient without concurrent changes in the way patients conduct their lives. As behavioral health providers, we can and should play an important part in helping our patients achieve true health.