Disease-Centered vs. Patient-Centered Care: Fixing the Flaws in Modern Medicine
One of the most profound flaws in modern medicine is mistaking managing symptoms for curing disease.
The most challenging hurdle I face is un-training patients and peers from a system that is fundamentally designed to manage sickness rather than restore health.
The conventional medical system operates on a "disease-centered" rather than “patient-centered” model. Traditional training essentially teaches practitioners to “name the disease, and then we have a treatment for it”. In other words: identify the disease, find a drug to match it, and suppress the most obvious symptom. This technological and market-driven approach views human beings as “cases” with a specific broken part. We fail to understand that a symptom is often just the tip of the iceberg.
To understand why practitioners genuinely believe they are treating disease when they are merely managing it, we have to examine how they are trained to view human physiology.
The "Tylenol for an Infection" Illusion
Let’s explore a very simple analogy from Dr. Christopher Palmer’s book Brain Energy to highlight the difference between managing and treating. Imagine you have a severe bacterial infection that is causing a high fever. If I give you Tylenol, your fever will drop and you will undoubtedly feel better. I can point to the thermometer and declare that the treatment worked.
However, Tylenol is a symptomatic treatment. It manages the symptom, but it does absolutely nothing to address the root cause of the fever, which is the infection. Without an antibiotic to actually cure the root cause, the infection will continue to rage inside your body, and the disease will progress. In modern medicine, we are effectively treating systemic, chronic diseases with Tylenol. We put a "Band-Aid over a stab wound" and call it healthcare.
The Trap of the "Surrogate Marker"
The primary reason the medical system believes it is successfully treating patients is because it is obsessed with chasing "surrogate markers". A surrogate marker is simply a number on a lab test, like Hemoglobin A1c (HbA1c) for diabetes or LDL cholesterol for heart disease. Practitioners are trained to aggressively drive these numbers into a "normal" range using pharmaceuticals, mistakenly believing that fixing the number equals fixing the disease.
The Diabetes Example: When we look at Type 2 Diabetes, mainstream medicine views it through a "glucose-centric" lens. When your blood sugar goes up, we prescribe drugs or insulin to force the sugar out of the blood. Your HbA1c drops, and the practitioner congratulates you on having your diabetes "controlled”.
But how did the drug lower the sugar? It crammed the glucose directly into your fat cells, your liver, and your pancreas, causing you to gain weight and increasing your visceral fat. Visceral fat and insulin resistance are the actual root causes of diabetes. So while your blood sugar looks perfect on paper, the underlying disease is silently accelerating, destroying your beta cells, and eventually leading to kidney failure, blindness, or amputation. You haven't cured the diabetes…you are just managing a number while the metabolic fire spreads.
The Cardiovascular Example: The exact same illusion exists in cardiovascular care. We place stents in arteries to restore blood flow, which can certainly be life-saving in an acute crisis. However, it doesn't change the outcome of the disease long term because the underlying mechanism (i.e. the inflammation and metabolic dysfunction driving the plaque) has not been addressed. We hand out statins to lower LDL cholesterol, and while they may slightly decrease acute events, they simultaneously increase insulin resistance, raise blood sugar, and increase visceral fat. We are pouring gasoline on the metabolic fire to fix a cholesterol number…and celebrating it.
Ignoring the Cellular Engine
Why does the root cause worsen? Because almost all of these chronic conditions, from cardiovascular disease to Alzheimer's to diabetes, share a common denominator: mitochondrial dysfunction and insulin resistance.
The mitochondria are the engines of your cells. When they become damaged by poor diet, environmental toxins, chronic stress, and declining hormones as we age, they can no longer burn fuel efficiently. This leads to a buildup of visceral fat (deep belly fat), which acts as a toxic organ that oozes inflammatory chemicals into your bloodstream. The medical system largely ignores this metabolic and mitochondrial breakdown because there is no simple pharmaceutical pill that fixes it and it cannot be treated in a standard 7-minute insurance-based office visit.
The “Silo Effect” of Medical Specialties
The medical system is heavily compartmentalized into distinct, standalone silos. We have cardiologists for the heart, neurologists for the brain, endocrinologists for the hormones (yikes!), and psychiatrists for the mind.
Because specialists stay in their own “lanes” or “camps” and rarely communicate across disciplines, they fail to see that almost all of these chronic diseases share a common root cause that I mentioned above: metabolic and mitochondrial dysfunction. A psychiatrist might prescribe an SSRI for depression, while an endocrinologist prescribes metformin for diabetes, and a cardiologist prescribes a statin for the heart…none of them realizing that they are all trying to put out different fires in the same burning house caused by cellular energy failure. The unfortunate and sad reality is that most of those medications cause collateral damage and worsen the cellular energy failure long term, but the patient is often told it’s because they need to eat better or exercise more.
Insurance Billing and the “Binary” Trap
The economics of the healthcare system actually mandate diseases rather than preventing them. Our insurance and billing systems are built on a binary framework: you either have a disease or you don’t.
If your lab numbers have not crossed a specific threshold to grant you an official diagnostic code, the insurance company will not pay for the intervention. But chronic diseases like type 2 diabetes or heart disease do not happen overnight…they are a slow, 10 to 20 year continuum of metabolic decline. Because the system forces us to wait until the disease is fully manifested to “treat” it, we miss the decades-long window of opportunity to fix the cellular engine and prevent the disease from happening in the first place. Science tells us prevention is the best option but the economics of the healthcare system prevents us from practicing it.
Guideline Inertia and Fear of the Medical Board
Finally, practitioners are terrified of deviating from the “standard of care” and suffer from debilitating cognitive dissonance. Healthcare professionals hesitate to deviate from accepted norms, even when the latest scientific data (or decades of historical data) proves those norms are outdated or harmful. Enforcement of strict medical guidelines places practitioners in a terrible position: they must either follow ineffective (but legally safe) guidelines or risk severe punishment from their medical boards for trying to treat the actual root cause (like optimizing hormones). Consequently, practitioners will practice defensive medicine, adhering to collegial advice right off the cliff because it is the safest way to manage their liability.
The Path to True Healing
The medical community mistakes management for treatment because they are structurally, financially, and educationally incentivized to chase surrogate markers, stay in their specialist silos, and suppress symptoms rather than doing the heavy lifting of restoring cellular metabolism and hormones.
To move from managing disease to treating and curing disease, we must abandon the practice of treating symptoms in silos. We have to target the root cause. This means restoring the body's cellular engines, optimizing hormones (like thyroid, testosterone, estradiol [but only in menopause!]) to naturally burn visceral fat and improve insulin sensitivity, and rigorously addressing nutrition (one of my biggest challenges).
We don't need to endlessly manage diseases with excessive referrals and a polypharmacy of pills. When we fix the underlying metabolic breakdown, the diseases effectively go into remission and patients reclaim their vitality and their lives, shifting from chronically ill to thriving.
- Luke Swift, DNP, APN-FPA, PMHNP-BC, ABHRT
