“Healthcare is broken.”

It’s a very valid statement to start this recent piece published in Time. Without a doubt, healthcare is broken. It was a driving reason for me to set up a private practice last year where I could practice medicine differently. And while this is a US article, make no mistake: both US and Irish healthcare are equally broken, just broken in slightly different ways. While the article delves into the economics of health – that we often overlook in a socialist healthcare system – the fact remains that healthcare – like any resource – is finite.

Where I disagree is that the author skims too lightly over what is formally termed Barriers to Health Behaviour Change. It’s not just hard, and it’s not just all things in a patient’s control: education, poverty, environment, genetics, trauma… all play their part.

Like so many discussions in today’s society, we are increasingly polarising these conversations to one extreme to another. Which is unhelpful.

On one side is the narrative of the doctor prescribing pills “The Big Pharma Shill.” This narrative often has a slightly American origin, portraying healthcare professionals as wanting patients to stay sick or on meds for profit. This falls apart in the Irish context: As I tell my skeptical patient routinely “If you haven’t heard, the HSE isn’t exactly looking for more business.”

On the other side is the rise of the trillion euro global wellness industry on the back of antiscience rhetoric as gurus promise apps, coaching and supplements. Sifting the evidence-based recommendations or truly qualified from the rest can be tricky. There is a myriad of well-intentioned-but-clueless or the profiteering woo-mongers or the influencer who will literally promote any idea or product for clicks in between the anti-science Tik Tokkers.

Health behaviour change is powerful.  But it’s not a miracle.  It’s hard work.  I work with my patients on it every day. But as the article points out: Health is what happens between visits to the doctor. But understanding where patients are at between those visits is the subtle but important difference between empowering and educating a patient to succeed– and blaming/shaming a patient who stumbles and falls..