Understanding Why We’re So Sick

I remember being very intimidated as I began the first few outpatient clinics of my residency. It seemed that almost all of the patients that I’d inherited from the graduating resident had more than one medical problem. Way more. As I recall, five or more was the norm. How was I ever going to take care of someone with obesity, hypertension, diabetes, hyperlipidemia, coronary artery disease, congestive health failure, chronic renal insufficiency and degenerative arthritis in a 15-minute or even 30-minute visit? I just couldn’t think that fast.

Gradually, I learned to manage the jigsaw puzzle of illness and medicines common to older adults in America today. Being an internist is a lot like being a symphony conductor. The conductor can’t just listen to the violins or the horns. He’s got to take in all the sound at once, focusing on the total musical experience, while still giving the individual instrument sections the attention they require

Even as I grew in my ability to help these complicated patients, I was still mystified by the lopsided nature of my new practice. Honestly, it was true that about 90% of my patients had many medical problems. I’d estimate that 10% or less had only one or two diagnoses. It was pure joy when someone would walk in with a simple case of hypothyroidism or another isolated condition.

What was going on? To me it felt like the illnesses or diseases were “ganging up” on the poor patients. And my patients seem to feel that too. Many seemed overwhelmed by their multiple conditions; beaten down by sickness they were unable to control. Most just got worse every year despite my best efforts.

At first I attributed this situation to the select nature of a “resident clinic,” which must have accumulated the sickest people over the years. I was sure that many healthier patients existed somewhere else. Then I noticed that my attending physicians’ clinics were likewise filled with patients having multiple chronic illnesses. “Perhaps it’s just the nature of a teaching hospital,” I thought until I met a doctor practicing in town. Same thing.

How could this be? Perhaps you are more perceptive than I was back then and have figured this out already, but it took me quite a while. Eventually I grasped the simple fact that the most common chronic diseases are not random events! They travel together. The same lifestyle factors that cause one disease cause others, and any particular disease will often cause other conditions as complications.

It happens like this: A man lives a sedentary life and eats a low-nutrient, high-calorie diet. Years pass. He becomes overweight and then obese. Along with the fat come hypertension, hyperlipidemia and type II diabetes. In turn, these three illnesses cause atherosclerosis throughout his body and he eventually suffers from strokes, heart attacks and kidney damage. With the development of congestive heart failure and chronic renal insufficiency, everything gets progressively more difficult to manage. Eventually the man dies after years of debility.

I don’t mean to “blame the victim” or deny randomness. Some illnesses are, for all practical purposes, random or otherwise unavoidable. But in the United States in today it’s a small fraction of them. According to the CDC, most of our healthcare spending goes for treatment of chronic, lifestyle-related conditions, and the the America Cancer Society has said that two-thirds of all cancer deaths are attributable to our lifestyles. Truly, the vast majority of our national health and healthcare problems are self-induced.

This is not conventional wisdom. Do you normally think of cancer as a lifestyle disease? When is the last time someone spoke to you about preventing cancer through losing weight, eating a healthy diet and exercising? Personally, I notice lot more media attention to needing additional “research for the cure” than about the simple steps we can take to be well.

I’m no longer a practicing internist, but I’m still trying to help people be well by other means, including this blog. Few are receptive to the message. Most people, most of the time, will choose to live the easy but disease-inducing lifestyle. Be different. It is possible to take control of your habits and it’s worth the work.


  1. Dexter Simanton says:

    thanks Pete, for speaking the truth.

  2. Peter Weiss says:

    You’re welcome Dexter, and thank you for your encouragement. Pete