The Care That Happens Before and After Disease

Imagine going to your physician for your annual physical. You have some blood work done, perhaps a few other tests, and everything comes back relatively normal. Your physician tells you that things look good, recommends eating healthy and exercising regularly, and encourages you to follow up in a year.

But you leave feeling like something is missing. Maybe you're still struggling with fatigue, poor sleep, or weight gain. Perhaps you feel reasonably healthy but want to know what you could be doing to reduce your risk of developing disease over the next twenty years. You were hoping to learn more about your health, what you could improve, and how to go about improving it. Instead, you're left with reassuring test results and some general advice.

I've heard this experience described by patients many times. And unfortunately, I've also been the physician providing that experience. It's not that physicians don't recognize the importance of nutrition, exercise, sleep, and other lifestyle factors. We know how substantially they can influence health. But the medical system doesn't always give us the time, training, or resources to address them in a meaningful way.

Think about what happens during a typical fifteen- or twenty-minute appointment. There's a medical history to review, medications to reconcile, chronic conditions to manage, symptoms to evaluate, and appropriate testing or screening to discuss. By the time those things are addressed, there may be very little opportunity to explore someone's eating habits, exercise routine, sleep, stress, or broader health goals.

And even when we have that conversation, what does it usually look like? We tell someone to exercise more, eat healthier, lose weight, or improve their sleep. All reasonable recommendations. But how much guidance do we actually provide to help them accomplish those things? There's an enormous difference between telling someone to exercise and helping them develop an exercise program that fits their needs, abilities, and life.

I think this is one of the important gaps in how we currently practice medicine. I've come to think of it as the before and after of conventional medical care. Modern medicine is incredibly capable when it comes to diagnosing and treating disease. As a hospitalist, I've seen firsthand how medications, procedures, and other interventions can save lives and improve outcomes.

But I often wonder about what happened before someone arrived at the hospital. What was their health like five or ten years earlier? Were there opportunities to improve their metabolic health, cardiovascular fitness, body composition, or other risk factors before significant disease developed? And if those opportunities were recognized, did anyone have the time and resources to help the patient act on them?

Then there's what happens afterward. We treat someone's illness, stabilize their condition, and send them home. But what are we doing to improve their underlying health and reduce the likelihood of future problems?

Preventive medicine, rehabilitation, and chronic disease management certainly exist within conventional care, and many clinicians do excellent work in these areas. The issue is that they aren't always integrated into a comprehensive approach that follows someone through the different stages of their health. That's the gap I think we should be working to fill.

One of the reasons I'm particularly interested in lifestyle interventions is that they can influence several areas of health simultaneously. Consider exercise. An appropriate exercise program can improve cardiovascular fitness, muscular strength, insulin sensitivity, blood pressure, mood, sleep, and aspects of body composition. Improving nutrition can influence cholesterol, glucose regulation, weight management, and cardiovascular risk. Better sleep may improve energy, mood, appetite regulation, and someone's ability to maintain healthier habits throughout the day.

These factors also influence one another. Someone sleeping poorly may struggle to find the energy to exercise. Their inactivity and eating habits may contribute to weight gain and declining metabolic health. As their fitness decreases, everyday activities may become more difficult, making exercise even less appealing. Addressing one of these problems can sometimes make it easier to improve the others. This is what makes comprehensive lifestyle interventions so valuable. We're not necessarily treating one isolated problem. We're working on several interconnected aspects of a person's health.

And there is meaningful evidence behind this approach. In the Diabetes Prevention Program, an intensive lifestyle intervention focused on physical activity, dietary changes, and weight reduction decreased the development of type 2 diabetes by 58% compared with placebo over approximately three years in adults at elevated risk. That's a substantial benefit from changing how people live.

Now, this isn't an argument against medications or conventional treatments. Those interventions can be incredibly important, and sometimes they're absolutely necessary. Take someone with elevated cholesterol and increased cardiovascular risk. A cholesterol-lowering medication may substantially reduce their risk of a heart attack or stroke. But that medication isn't going to improve their cardiovascular fitness, increase their muscular strength, or correct their sleep habits.

Exercise and nutrition can improve several of those factors, but they may not adequately address the person's cholesterol-related risk on their own. So why would we choose between the two approaches when the patient might benefit from both? I think that's where comprehensive care becomes particularly valuable. We're combining effective medical treatments with interventions that improve the broader factors influencing someone's health.

Of course, understanding these relationships is only part of the process. We also need to figure out how to help someone make meaningful changes. Imagine a patient in their forties who's gaining weight, feeling increasingly tired, and noticing that their exercise tolerance isn't what it used to be. We should absolutely evaluate them for medical conditions that could explain their symptoms. But if that evaluation is reassuring, our work doesn't necessarily have to end there.

Maybe they're sleeping six hours a night, working long days, eating inconsistently, and struggling to maintain an exercise routine. Their declining activity and dietary habits may be contributing to changes in body composition and metabolic health. Their poor sleep may be making everything else more difficult. Now we have a better understanding of the person rather than simply a collection of laboratory results. We can begin identifying which changes might provide the greatest benefit, determine what's realistic within their life, and build a plan around those priorities.

Sometimes additional laboratory testing or physiological assessments, such as body composition or VO₂ max testing, can help us better characterize someone's health and guide those decisions. But more testing isn't inherently better. The information needs to be useful and connected to something we can actually do.

And once we've developed the plan, we need to help the patient carry it out. That's often the hardest part, and perhaps where we have the greatest opportunity to improve care.

A physician can recommend healthier eating in a matter of seconds. Helping someone understand what that means for their nutritional needs, food preferences, work schedule, and family life takes considerably more time. The same goes for exercise, sleep, and other lifestyle factors. Sometimes that means involving a dietitian, exercise specialist, or another professional who can provide expertise and support. Sometimes it means adjusting the plan repeatedly until we find something that works.

The goal isn't to overwhelm someone with recommendations or pursue perfect laboratory numbers. It's to help them make sustainable improvements that meaningfully affect their health and the life they want to live.

This is the philosophy behind how we're building Archetype Medicine. We believe there's tremendous value in understanding the whole person, identifying opportunities to improve health before disease develops, addressing lifestyle factors alongside medical treatment, and helping people maintain or regain their health after illness.

I don't think conventional medicine needs to be replaced. I've spent much of my career working within it, and I have enormous respect for what it accomplishes. But I do think it needs to be complemented by a more comprehensive approach to prevention, lifestyle, and long-term health.

Because there's more to caring for someone than diagnosing and treating disease. There's also the work of helping them become healthier before they get sick, supporting their health while they're being treated, and helping them build a healthier life afterward. And I think that work deserves a much larger place in medicine.