Traditional Medicine Treats You as an Equation
The cookie cutter approach is harmful. Here’s how to get better care.
If you’ve ever gone to the doctor and blanketly told that you need a medication because of a number in your chart then you got the short end of the clinical stick.
Far too often, Western Medicine treats people the same without discussing the subtleties of each case. Without diving deeper and having a truly informed discussion.
But this isn’t because your doctor is bad, you have some responsibility here as well. Trying to reduce clinical medicine to an online equation or a 50 second video clip can be harmful.
Welcome to the Physician-Led Health Coaching weekly newsletter. I’m Dr. Ashori, a board-certified physician & health coach. I help people fix brain fog, fatigue, and stubborn weight before they turn into real disease.
High Blood Pressure
Imagine you are in your mid 30s and noticed a few high blood pressure readings. Your doctor checks it and confirms it’s too high at 150/92. They cite the JNC8 Guidelines and recommend you start treatment with a medication.
But that’s not how high blood pressure works. It doesn’t exert the same effect on every body the same. The reason we treat your blood pressure is to decrease your baseline risk.
What is your baseline risk? If it’s very high, the medication is likely a life-saver. This might apply to 20% of the population. If you have no family history of heart disease, kidney disease, strokes, or other complications from high blood pressure then your baseline risk is really low. Adding a blood pressure medication would lower your miniscule risk by a tiny amount.
Elevated A1C
Almost every primary care doctor will order an A1C test on every patient annually. It’s meant to pick up a signal that your blood sugars are too high and you should do something.
A high A1C means there could be a potential risk for diabetes in the future. The problem is that we don’t know which patient will end up developing diabetes.
My mother is nearly 80, thin, exercises daily, and it’s a mostly plant-based, minimally processed diet. I’d consider her healthy - whatever that might mean. But her A1C is 6.0. Her doctor even recommended a medication to treat it.
So, my mother at 98 lbs is being treated the same as someone who eats fast food daily, doesn’t exercise, and carries 50 extra lbs.
Paroxysmal Atrial Fibrillation
Most of my patients are in their 30s-50s, but I have a few patients I take care of in their 70s and 80s. One of my 75-yo patients was just told that he needs life-long blood thinner treatment because his watch notified him that he might have Atrial Fibrillation.
He’s active, low-stress, drank alcohol only occasionally, exercises, and has a healthy weight, and no other medical problems. In fact, the only bout of Afib he got once he wore a rhythm monitor was because he had some Tequila.
The cardiologist plugged his age into a calculator and it said he needs to be treated, so that was the decision. This is bad medicine. Because if he was 100 lbs overweight, sedentary, drank alcohol daily. and had high blood sugars, he’d be given the same recommendation.
But blood thinners, just like meds for diabetes and hypertension, aren’t without harm and risk.
Obesity
Now imagine you have an extra 15 lbs and your doctor (or social media) recommends a GLP1. You’re otherwise quite healthy and a DEXA scan confirms that most of your extra weight is subcutaneous fat.
What’s the benefit of this medication? What’s the benefit of you even losing this 15 lbs but lowering your calorie intake? Not much, that’s the answer.
There is a risk when you carry extra weight. But it’s not the same for everyone. If your baseline risk is incredibly low then decreasing that weight won’t add anything to you. If you have $1M in the bank and I give you 1 penny, nothing happened.
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Back Pain
The harm of overtreatment with back pain could be called an epidemic. Okay, I’m exaggerating but I can think of so many of my patients who had back pain, got an MRI, then told they have a herniated disc and needs surgery.
There’s no time in traditional medicine to really put you through an intensive physical therapy program, reassess your pain, tease out whether it’s truly damage to the nerves or just back spasms.
The equation here is that you had a herniated disc on an MRI = surgery. But the reality is that most herniated discs resolve on their own. It’s worth a try.
The Role the Patient Plays
I’m just a Family Medicine doctor. I’m not a specialist, certainly not a cardiologist. When I push back on the recommendation of lifelong anticoagulation for paroxysmal AFib I’m told by the cardiologist in no uncertain terms that they are the expert.
My patient, too, will push back and say, hey look, you’re a Family Medicine doctor, the cardiologist knows better. I disagree. The cardiologist knows some things better, not all things. She’s perfect for a complicated AFib case but not for a borderline case.
If you just put your head down and go along with whatever an expert says then you risk getting swept up with guideline-based medicine. Yes, your specialist is an expert but you should always verify what you’re being told.
Disclaimer:
Dr. Mohammad Ashori is a U.S.-trained family medicine physician. The content shared here is for education and general guidance. It is not personal medical advice, diagnosis, or treatment, and it does not create a doctor-patient relationship. Humans are complicated and your personal details matter. Your healthcare team is your best resource before making medical decisions, changing medications, or managing symptoms. This information is to help you add more depth to those conversations.
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