Dear readers,
In theory, our healthcare system exists to help people live healthy lives. In reality, we’ve created a sophisticated sick care system that excels at treating diseases but largely fails at preventing them.
The Evolution of Sick Care
Modern medicine has achieved remarkable feats. We can transplant organs, eradicate certain infectious diseases, and perform microsurgeries unimaginable a century ago. These advances, driven by dedicated physicians and researchers with genuine desires to alleviate suffering, deserve celebration.
However, our medical system has evolved into an industrial complex that constrains how medicine is practiced. The financial incentives increasingly prioritize volume over quality, procedures over prevention, and standardization over personalization. A patient with well-controlled diabetes requires only inexpensive medications and preventive care, while a patient with poorly managed diabetes may need kidney dialysis, eye surgeries, and numerous hospitalizations—generating millions in revenue.
This perverse incentive structure hasn’t happened because of doctors’ intentions. Physicians enter medicine to heal and help people—to form relationships with patients and guide them toward better health. Instead, many find themselves caught in a system that values throughput over therapeutic relationships and billable procedures over meaningful outcomes.
The Food System’s Contribution
While our medical system has transformed into one focused on treating diseases, our food system actively creates them. The modern food industry has engineered products designed to override natural satiety signals with hyperpalatable combinations of salt, sugar, and fat that drive overconsumption.
Processed foods now dominate the American diet, contributing to chronic inflammation, insulin resistance, gut dysbiosis, and hormonal disruption. These physiological changes become the precursors to chronic diseases that physicians then must treat—often without adequate time to address underlying dietary causes.
Most physicians receive minimal nutrition education during medical school, not by their choice but due to curriculum decisions beyond their control. Many doctors recognize this gap in their training and feel frustrated by their limited ability to address root causes when faced with the consequences of our food environment. This isn’t a failure of individual doctors but a systemic limitation that leaves even the most dedicated physicians without the tools they need to truly address the origins of metabolic disease.
The Narrowing of Medicine
As our medical system evolved, it systematically marginalized approaches that didn’t fit within its pharmaceutical and surgical paradigms. This shift wasn’t driven by physicians themselves, who enter medicine with genuine desires to heal and help people. Rather, it reflects broader systemic constraints.
Most doctors chose their profession out of compassion and a calling to make a difference in patients’ lives. However, they increasingly find themselves trapped in a system that limits the time they can spend with patients, rewards procedures over prevention, and creates administrative burdens that lead to burnout.
Nutritional interventions, despite substantial evidence supporting dietary approaches for conditions like type 2 diabetes and autoimmune disorders, are rarely prescribed as first-line therapy—not because doctors don’t believe in their efficacy, but because the system provides little time, training, or reimbursement for these approaches.
Lifestyle medicine—focusing on exercise, stress management, sleep hygiene, and social connection—receives minimal attention in most medical encounters despite many physicians recognizing its profound impact. The typical seven-minute appointment simply doesn’t allow for the nuanced conversations required to help patients implement meaningful lifestyle changes.
The exclusion of these approaches hasn’t been based on physicians’ preferences or beliefs. Rather, it reflects a healthcare structure designed around billable procedures, pharmaceutical interventions, and high-volume patient throughput that constrains doctors’ ability to practice medicine as they were trained and as they deeply wish to.
The Consequences
The results of our sick care approach are evident: 60% of American adults have at least one chronic disease, 40% have two or more, and healthcare spending continues to rise while outcomes lag behind other developed nations. Despite spending nearly 20% of our GDP on healthcare, Americans are experiencing declining life expectancy and rising rates of chronic illness.
This paradox reveals the fundamental flaw in our approach: we’ve built a system that responds to disease rather than creating health.
Reimagining True Health Care
A genuine healthcare system would prioritize prevention and address root causes rather than merely suppressing symptoms. It would embrace nutritional medicine and recognize food as a primary driver of both disease and healing. It would integrate multiple evidence-based healing modalities regardless of whether they involve pharmaceuticals or surgery, and realign incentives to reward maintaining health rather than performing procedures.
Some encouraging shifts are already underway. Lifestyle medicine is gaining recognition as a specialty. Functional medicine approaches are demonstrating effectiveness for complex chronic conditions. And patients themselves are increasingly seeking care that addresses root causes rather than merely managing symptoms.
Being Your Own Health Advocate
Until systems change, individuals must become their own health advocates while recognizing that most physicians are allies in this journey—even when constrained by the system. The best doctor-patient relationships become partnerships, with patients taking active roles in their health and physicians applying their expertise to guide and support that journey.
Seek physicians who still manage to prioritize root causes despite system constraints. Many doctors are finding creative ways to practice more holistic medicine, whether through concierge models, functional medicine approaches, or simply by fighting to spend more time with fewer patients. These physicians often feel as frustrated with the limitations of the system as their patients do.
Remember that health creation happens primarily outside of medical facilities—in kitchens, bedrooms, workplaces, and communities. Your doctor may have just seven minutes with you several times a year, but you make health decisions multiple times daily. Working together, informed patients and dedicated physicians can begin to shift the focus back to true healthcare.
The future of healthcare isn’t found in more sophisticated disease management—it’s in rediscovering what creates genuine health in the first place, and in rebuilding a system that allows doctors to practice medicine the way they originally intended: as healers, educators, and partners in health creation.
Best,
The Gajer Practice
