The most important elements of wellness are reason, exuberance, athleticism and liberty. The acronym for these four dimensions is REAL. REAL wellness avoids the confusion that often occurs when wellness is sent out into the world without a bit of specificity for protection. The term wellness has been bandied about so recklessly over the past four decades that a modifier that signals a clear emphasis is essential to clear communications about the concept. These four areas are the most important elements of wellness, in my opinion. For this reason, I believe a new medical specialty is needed. Medical doctors who care about healthy lifestyles should be trained to deal in four REAL wellness specialty areas.
What follows is an outline for a new medical specialty area for fitness and nutrition, both of which are part of the element of athleticism.
In 2012, the AMA Physician Masterfile of specialty practices stood at 200 categories, with another 140 officially recognized subspecialties. (Source: Association of American Medical Colleges 2012 Physician Speciality Data Book.)
The range of disciplines is impressive and demonstrates the devotion our medical system has for diseases and dysfunctions. The range of specialties extends from A (allergy and immunology) to V (vascular surgery). Unfortunately, there is no specialty for dealing with what might be the most common disorder, a condition that afflicts hundreds of millions of sufferers in Western nations. I refer, of course, to Sedentarius Dysfunctionitis.
Sedentarius Dysfunctionitis or SD is a dreadful condition that presents itself in a wide range of disorders, all brought on by mental deficiencies, genetic abnormalities, adverse environmental factors and, rarely, absence of suitable information/education. All such factors contribute to the common inability of citizens throughout the developed world to sufficiently manipulate and engage their organs, muscle groups and ancillary body systems in movements at sufficient frequency, duration and intensity levels. This failure leads to a range of health-diminishing conditions and diseases, including obesity, high blood pressure, heart disease, diabetes and much else. Hapless millions face the reality of cantdoit and become vessels for medical billing codes in a sickness system still badly in need of repair.
Therefore, it is inexcusable, outrageous, scandalous and shocking that no medical specialty exists to provide treatment, not for the symptoms of SD (at least half of all specialists treat the myriad SD-caused illnesses and diseases) but for the condition of SD itself. As long as people suffer from SD, specialists in at least 100 specialty categories will have ample opportunities to stay busy and prosper treating those who suffer from symptoms of SD disorder, while the disorder itself will go undetected or at least untreated.
The Role of the Physician Fitness Specialist
The doctor who specializes in treating SD will have to know, in addition to mastering the standard medical school curriculum and other requirements for licensing in that profession, advanced training in exercise physiology, the psychology of motivation, the nature of REAL wellness and a range of similar skills that permit assessment and counseling, experimentation, research and more. He will have to understand related fields, such as nutrition and positive psychology.
However, one area that will occupy her or his time with patients to a considerable extent will be diagnosing and helping the patients reform lifestyle-generated metabolic, musculo-skeletal and psychological dysfunctions. These, after all, are the foundation elements in the onset and persistence of SD. Rather than prescribing drugs or engaging in invasive interventions, the Fitness specialist M.D. will prescribe and monitor, often assisted by a team of professionals within the exercise arena, exercise and fitness regimens. These patient-centered plans will be keyed to aerobic fitness, strength and flexibility. A standard goal will be the restoration and maintenance of sound metabolic, musculo-skeletal and psychological stability and strength.
An example of the detailed focus of the Fitness Specialist might be assisting SD sufferers regain needed levels of strength and flexibility. The doctor will want the pelvis and bones above it to align, else joint and muscle pain will persist. Weak musculature does not enable a person to manage typical everyday tasks without breakdowns because muscles take bones out of alignment. The Fitness Specialist doctor will know that pain sites are rarely the causal areas of pains experienced. He will know where to look for the problem and proscribe routines and lifestyles that get at sources, not symptoms.
As Australian physical educator John Miller, has long maintained, it is a big ask to expect anyone to stay healthy without keeping him or herself fit. It’s an even bigger ask expecting to get better by having someone do something to you; sooner or later you have to do something to yourself.
Health without exercise and fitness cannot be maintained – at least not for long. Medical spending would be a fraction of what it is today (nearly 18% of GDP in the U.S. – it was 6% in 1965) if we had half as many doctors treating SD as we have treating allergies, performing vascular surgeries and practicing the other specialties in-between. Too many physicians devote their talents to relatively rare as well as end stage disorders. It is long past the time for getting our national health system doctor specialty house in order. It’s time to create specialists in the all too common maladies of SD caused by dysfunctions brought about my underuse of major body systems, particularly the cardio-vascular, digestive and musculo-skeletal systems.
Have a look at the Miller model continuum shown below, one of countless variations on the classic model created in the early 70’s by John Travis, M.D. and first promotion at the world first Wellness Center, located in the heart of downtown Mill Valley, CA. Every malady and malaise known to man and woman exists on this continuum from the Tipping Point in the center all the way to the far left of the continuum – the dreadful nadir or slough of despond point of physical worseness. This is the field of play for all 200 medical specialties. Now look to the right of the Tipping Point on the graph. This would be the province of the medical doctor fitness specialist.
Be well, exercise daily, get fit and stay that way. No point waiting for medical leaders to create a new specialty of doctors to look after you when you get SD.