Dr. Habib talks about why the current healthcare system is not good enough for you. Transcript below: Hi this is Dr. Habib. Today I want to try to go over what determines whether a doctor discusses blood pressure versus arthritis versus cholesterol on any given office visit. So first, some of the logistics, and then I'll delve into the medial aspects, and finally, hopefully the way it should be done. So you may imagine that the doctor's very smart. He's figured out which is the most important criteria for that office visit. And what I want to tell you is that let's look at what is involved in that decision making. Number one, the duration of the visit. So if you have a physical, it's a long visit, minimum 30 minutes. It could go long as an hour. Just depends on the doctor, really. It's beyond what depends on the doctor. If he wants to get reimbursed, he has to spend about 45 minutes, go over certain points to be able to check off, in order to call it a physical for reimbursement purposes. So it's really not about what he wants to do and how much time he wants. He's being driven by what reimbursement he's looking for. So physical is a complicated, or annual physical, so based on the fact that it's gonna be more detailed, a longer process, then it should warrant more time. But for the average visit, it's about 15 minutes. My joke is and it's not really a joke, 'cause it's a serious joke, it's five minutes to check in with the receptionist and your insurances and all that paperwork. And it's probably about a few more minutes with the medical assistant checking the blood pressure, the height, the weight, and then you get about five minutes with the doctor. And a few more minutes to check out again. So that 15, 20 minutes was literally only five minutes with the doctor. And that's not a joke. That's kind of unfortunately the reality. And in that short period, let's just say, that short period of time, that office visit, how did that doctor figure out whether we should talk about the blood pressure today, the cholesterol today, the acid reflux, the joint pain, the rash, how did he figure that out? Well, like I tell you, if somebody came in with an acute problem, it's different. Your shortness of breath. That could be mild, but we're trained to look at all the possibilities, so even though it may seem simple, we should be prepared for a long visit because it could be a pneumonia. It could be a pulmonary emboli. It could be a chronic obstructive lung disease. It could be asthma. It could be a inflammation, a pneumonitis. The point I'm saying is that, that for acute problems, it's variable, but things like blood pressure, cholesterol, diabetes, these are very stable, and so the doctor's already pre-programmed himself to know, I'm only going to spend 15 minutes, of which you know it's not really 15 minutes, on cholesterol, blood pressure, diabetes. And so the myth is, you would imagine that the doctor had figured out which is the priority, and I'm gonna at the end of this video, dispel that. Dismiss that concept. And what I want you to understand is that, he is going to be discussing a subject matter with a duration of time that's gonna match the reimbursement, so he's actually practicing under the parameters, of what the insurance reimbursement. That means diagnostic codes, procedure codes, reimbursement. And not because of what he deems is the most important thing. So let's use some examples. Cholesterol's pretty benign. You have to have cholesterol for a long time, where there is any association with cardiovascular problems. Blood pressure, same thing. The fact is that you could have blood pressure for one week, one month, six months, one year, no acute problem will happen. In fact, we know it takes decades for the blood vessels to get stiffened up before the heart starts to get bigger. And so I'm not condoning waiting a decade without treating it. All I'm saying is that there are certain things that need more of a priority. Like acid reflux. Look you have pain and the pain is because either there's too much acid in the stomach or gastritis, or that acid is going up behind the chest. Gastroesophageal reflux disease. Either one is at the very least, uncomfortable because after you eat, you could have pain. When you're trying to sleep at night, you cough. The reflux is irritating the oropharyngeal area. You could have chest tightness. You could even mimic chest pain, like you're having a heart attack. In fact most of the hospitalizations, at least the 24-hour observation is where people go in with chest pains, majority of which is acid reflux because by default they excluded heart attack, okay? Now so that's fairly acute and it should be addressed. So you'd imagine that the doctor would maybe give you a strategy like, okay why don't we see if can do lifestyle changes. Get rid of dairy, get rid of acidic products like citric acid from foods, maybe cut that back on tomatoes and bananas, lose a little weight, And if the symptoms are a little bit more severe, then maybe he'll say why don't we use a medication over the next few weeks just to calm down the acid because you know, beyond the pain, it's eroding, it's damaging the lining in the stomach, damaging the lining in the esophagus. There's complications if you don't manage that. And I can go into that a little bit later. But so with the medication, you would temporarily cut the acid, giving the lining time to heal and the doctor has now given you advice on how to change your lifestyle. And so at the end of the four to six weeks, that's how long the FDA has approved the acid lowering medication for, and when you stop the medication, theoretically your symptoms should be over. But as you know, most people's symptoms persist, so doctors continue on that medication. So here I want to put it together for you now, is that about one in four people have acid reflux disorder of some kind. That means gastritis, esophageal reflux, mild, moderate, severe, the whole bucketload of spectrum of people. It's about one in four. It's interesting how adults, particularly between say 40 and 60, there's about one in three have high blood pressure. Mmmm that's interesting. So could there be a link? And now I'm getting to how the doctor should be thinking and putting it together in determining when the office visit should occur and what should be discussed, as opposed to, well you know I've got 15 minutes so I'll just bring you in for blood pressure 'cause that's all the insurance will reimburse me. I'll bring you in for 15 minutes for cholesterol 'cause that's all the insurance will reimburse me. Just being a devil's advocate, when the doctor, a good doctor, if he was so good and he just addressed everything at once, he will not get reimbursed for everything at once because it's all about that time factor, right? Time factor and that's unfortunate because that determines the activity, the behavior, the decision-making of the medical practice, including the doctor. That's unfortunate. So let me summarize again, the doctor's not deciding the condition to manage based on priority, unless it's an acute problem, like breathing problem, a chest pain, or of the chronic stable conditions, blood pressure, cholesterol, diabetes. Those don't determine, those don't require any prioritization, unless it's something like an acid reflux. But here I'm trying to tell you that acid reflux is quite common. One in four people. Blood pressure is even more common, one in three in that of population. Could there be a link? Well here's the link. When you are being treated with acid lowering medication, and that means that the acid in your stomach has been minimized, you will not be able to produce a lot of products like nitric oxide. So nitric oxide helps blood vessels open up increase blood flow. When you open up blood vessels, they are under less pressure, so blood pressure would come down. Conversely, if you're shutting off the acid, and your body's not making nitric oxide, then theoretically you have tighter blood vessels, so that's where the blood pressure starts to go up. And the problem is that nothing happened overnight. So the stomach problems were probably brewing for some time, and the blood pressure doesn't just go up overnight. So as, say the acid problem and the acid lowering medicine has been driving down the nitric oxide, and the blood pressure is gradually going up, maybe below 135/90, so you don't treat it. And that's the priority that I want to talk about, is that the doctor should be trying to links things together. So this is the analogy I want you to think about. So if you have cholesterol, most doctors will recommend at some point, theoretically after six weeks of lifestyle changes, that's what the CDC recommend Center for Disease Control recommends six weeks pretty much for all conditions, blood pressure, cholesterol, high blood pressure, I'm sorry. Blood pressure, cholesterol, diabetes, acid reflux, all that start with number one, number two lifestyle changes, diet and exercise. Then medication. How many times have you heard that from your doctor? Not too often, unfortunately. That's what the CDC recommend, not medication first. So if you have somebody that is coming in with blood pressure, cholesterol, or diabetes, and we're treating the blood pressure number with a blood pressure lowering medication, that's two-dimensional medicine. The high cholesterol with a cholesterol medication, that's two-dimensional medicine. The blood sugar being brought down with the blood sugar medicine, diabetic pill, that's two-dimensional medicine. And I just gave you a window into a little bit of a multi-dimensional, and eventually you'll understand it should be three-dimensional, which is that there's a link between the stomach acid and the blood pressure. They should not be two different visits. They should be put together because that's the right way to do it. In fact, underlying all of those c
