The Upstream Doctors

by Rishi Manchanda

We all think we know what good medicine looks like: smart doctors, stethoscopes, imaging machines, high-tech tests, and the best prescriptions and procedures money can buy. But that picture is vastly incomplete. In this eye-opening book, physician Rishi Manchanda says that our health may depend even more on our social and environmental settings than it does on our most cutting-edge medical care. Manchanda argues that that the future of our health care depends on growing a new generation of health care practitioners. We need doctors who look upstream for the sources of our problems, rather than simply go for quick-hit symptomatic relief. These upstreamists, as he calls them, are doctors and nurses on the frontlines of medicine who see that health (like sickness) is more than a chemical equation that can be balanced with pills and procedures administered within clinic walls. They see that health begins in our everyday lives, in the places where we live, work, eat, and play. If our high-cost, sick-care system is to become a high-value, health care system, the upstreamists will show us the way. (Description taken from TED Library: http://www.ted.com/pages/tedbooks_lib...)

Genres: Nonfiction, Medicine, Health Care, Science

112 pages, Kindle Edition

First published June 6, 2013

Reviews

[Donna Bergman · Rating 5 out of 5]

Mandatory read for all in healthcare

Great read. On point, gives specific case examples and is absolutely replicable. As a non-clinical healthcare administrator, I found it to be inspirational and actionable.

[Yahia Aktham · Rating 4 out of 5]

https://blog.ted.com/investigating-th...

[Nisha Muchhala · Rating 3 out of 5]

Truly valuable concept that Manchanda tries to explain - in that illness is more than the medical explanation for it but a proponent of our social and physical environment. He explains how important it is for doctors to look 'upstream' to the causes of our health (including social, economic and physical causes) rather than simply reacting to the presentation of symptoms from downstream. Bit wordy at times, a little bit self-promoting but nevertheless worth a quick flick through.

[Tom Panning · Rating 5 out of 5]

It's generally accepted that doctors are supposed to find and treat the root cause of the patient, but Rishi Manchanda wants to push the definition of "root cause" further. If a patient complains of a runny nose, of course a doctor shouldn't just provide a decongestant and call it a cure. But if the runny nose is caused by an allergy to mold, many doctors would consider it normal to provide an allergy relief medication and advise the patient to be careful to prevent mold from forming in their home. Manchanda takes it several steps further. If the mold is because of poor plumbing in an apartment with an inattentive landlord, Manchanda connects the patient with advocates that can help the patient make sure the landlord fulfills the legal requirements to maintain the property. And if this is a repeated condition across several patients in a community, then Manchanda works with community leaders to raise awareness among tenants and landlords that this causes specific health problems, and what needs to be done about it.
Manchanda's focus is on encouraging more of these "upstream"-style doctors, and the various barriers that discourage and prevent upstream approaches. Although he does mention how other professions can be involved, my only quibble with the book is that there it's too focused on what medical professionals need to do. I'm hopeful that other authors will step in to fill this gap. Overall, the book presents its case clearly, with a good balance of examples of specific patients, along with studies.

[Val Finnell, MD, MPH · Rating 2 out of 5]

This is a quick read with only one good idea and that is problems should be addressed "upstream" rather than downstream. In other words, we should try to look for solutions to problems at their source rather than dealing with symptoms. But it is really a liberal shill for just about every social engineering program that exists. A simple follow on Manchanda's Twitter will reveal prostrations to the Affordable Care Act, contempt against physician specialists, and advocacy for gun control (the most downstream of all solutions to violence!).

Save yourself some money and don't buy this Kindle book The only good idea is that we look for root causes to problems. It's really a front for a socialized medicine agenda.

[Jimmy Who]

Such doctors do exist in our society, they're called Naturopathic Doctors and/or Alternative Medical Doctors. They emphasize prevention, lifestyle changes and identifying/managing the root cause of disease. Too bad the social politics of western medical culture and the stubborn need to praise evidence-based medicine has blinded the majority to something so fundamentally simple as maintaining a healthy lifestyle. Needles to say, the reason why "upstream doctors" are so scarce these days is because the society have somehow been brainwashed to grant the "downstream doctors" the power of the god complex, while traditional effective natural methods as basic as drinking water have been frowned upon simply because the scientific community fails to find significance.

[John · Rating 2 out of 5]

The author makes the observation that our healthcare system is entirely oriented towards treating "downstream" illnesses that result from "upstream" causes like poor housing conditions, social stressors, and contamination of food and water supplies. From there, the book offers a few interesting anecdotes about sick patients whose symptoms cleared only after medical professionals looked upstream and found ways to identify and address causative circumstances. For me, the central idea of the book was intriguing but the solutions offered seemed feckless (e.g. ask your doctor if they're an "upstreamist" and if not patiently explain what the term means as a way to catalyze interest and change).

[Wilfred Arasaratnam · Rating 4 out of 5]

This book is like a cross between a pamphlet and a paperback on Kindle - ie it's a bit shorter than your typical book. It is part of a series of books inspired by TEDx talks. Dr Manchanda knows what he is talking about and I do like his approach to health and healthcare. I'm no expert in this area but I do wonder if we can achieve better health outcomes from looking at the wider society rather than curing the ill at the point of disease (when it maybe too late!)

[Michelle · Rating 4 out of 5]

Dr. Manchanda is extremely knowledgable and presents his views in an easy to understand and readable manner (even for the lay person). I absolutely agree that health issues can be more properly addressed if we look at these issues from a societal perspective and address matters from the root cause. This is equally important from a mental health perspective.

This was a great read and I certainly hope to see health care move in this direction! Very inspiring!!

[Kathy Kraft · Rating 3 out of 5]

It's true, most patient's problems are "upstream" but the "fix" for this is that there is no fix that is currently woven into our current medical system. It is expensive to do, even with a comprehensivist or extensivist program and often the rewards are few. Someday our current delivery of medicine will have to change so that these problems can be addressed.

[Eva Cg · Rating 4 out of 5]

Okay, but rather of the "You don't say?" sort.

[Jennifer · Rating 3 out of 5]

Another interesting TED book.

[Michelle · Rating 5 out of 5]

This book is interesting and full of good information. Thought provoking.

[Wil · Rating 4 out of 5]

YES. This book is full of wisdom and inspiration. The afterword by Paul Farmer was excellent as well.

[Bud · Rating 5 out of 5]

A compact rationale for a preventionist outlook in medicine. I'm using his concepts in my presentations.

[Paris Martin · Rating 4 out of 5]

quick and informative read on social determinants of health and potential solutions

[Cynthia · Rating 5 out of 5]

This should be required reading for all college students.

[Amy · Rating 4 out of 5]

A good primer on the importance of social determinants of health on healthcare.