For example, the balance problem in a diabetic patient or the knee pain in an obese patient. Part of that may be due to our healthcare system - how we are taught to enter a problem into the system, and even why. It also has to do with how clinicians are paid.  I used to bring up “coding and billing” in my courses and many of the students would make a face and even ask, “why do we have to discuss that...we just want to help people.”  It matters, but why?  Because it is also about the cost of healthcare.  For example, the association of Type 2 diabetes is multifactorial itself and can affect the reason someone is seeking care for foot pain in a physical therapy, chiropractic, or podiatry clinic.  Having more than one concurrent condition (technically, diseases) is defined as a comorbidity.

From deprived to affluent populations, the percentage of adults in English speaking areas is >1 comorbidity 67-72% of females and 59-64% of males, respectively (Nowakowska et al 2019). As mental health issues continue to rise, so do the associated costs.  In just reviewing the United States, sedentarism is close to 60%, obesity is 42%, and prediabetes is over 50%, with diabetes as high as 30% in some demographics.  Then of course there are musculoskeletal problems.  For osteoarthritis alone, the US consumes around $350 billion/year with direct healthcare costs and associated loss of productivity.  From 1996 to 2016, the US went from $1.4 trillion to $3.1 trillion (about $9,500 per person in the US) in healthcare associated costs, that is 17.9% of GDP (Dieleman et al 2020).  Low back and neck pain costs were tied at number one with $134.5 billion per year, number two was other musculoskeletal and pain at $129.8 billion and number three was diabetes at $111.2 billion.  Other conditions that did not win gold, silver or bronze but were standouts include heart disease, osteoarthritis, dementia, hypertension, urinary and skin.  Cost does vary by demographic I.e., the osteoarthritis cost is higher in older adults, and of course, there is an interrelationship for many. 

As clinicians, we need to provide a diagnosis code for what we are treating (for multiple reasons) and in some cases this tends to narrow our focus. However, conservative medicine could expand the amount of people managed if both practitioners and people broaden their view of what conditions can be treated and how they should be managed.   The result?  It might be possible to reduce the progression of certain conditions that might otherwise become more expensive to manage but potentially could even improve what we do tend to focus on. 

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