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In a new book, Dr Lucy McBride aims to help us navigate US healthcare – and tread carefully in the wellness industry
Read full story on theguardian.com →
Wellness — Elle Hunt
Most of us want to be healthy, but it’s easier said than done. In the US, people are caught between a broken medical system and a well-resourced wellness industry. The failings of the former – cost barriers, rushed appointments, impersonal attention – push them towards the snake-oil solutions of the latter.
Over 25 years of practicing medicine, running a primary care practice in Washington DC, Dr Lucy McBride has seen patients struggle to navigate the medical system.
In her new book, Beyond the Prescription , McBride presents a practical framework for getting the best results from a flawed system. It begins with defining what health means to you. For one person, it might be running ultramarathons and extending longevity at any cost; for another, it might be balance and the freedom to indulge.
“The relationship between a patient and their primary care doctor is, at its best, one of the most protective forces in human health – and, right now, we’re systematically dismantling it,” says McBride over Zoom.
It’s no wonder patients feel unheard, unsatisfied and lost. We spoke about how people can advocate for themselves and pursue their vision of health. Our conversation has been condensed and edited for clarity.
Why do you think people have lost trust in medical institutions?
Who do you trust in your life? Someone who listens, who has time, who’s curious, who asks appropriate follow-up questions. In the case of medicine, it’s someone who isn’t trying to give you quick answers for profit or rush you out the door.
But the medical system in the US has become episodic, transactional and impersonal; it privileges the volume of patients seen, and processing them instead of caring for them. The system tends to treat people like a set of body parts. The US public is frustrated.
Related: My $30,000 health insurance claim was denied. Then I tweeted about it
I think we all know the insurance industry [is at fault] as well, but when your doctor’s hand is on the doorknob and they’re rushing you through an appointment, it’s easy to blame them.
Have we overcomplicated the question of health?
The basics of human physiology – the need for physical activity, regular nourishment, sleep and social connection – haven’t changed over time.
The hardest part of my job is helping people to effect behavioral change and meet those basic needs: starting an exercise program, prioritizing protein in their diet, quitting alcohol, whatever it is.
People like protocolized routines, such as intermittent fasting, but most can’t adhere to them; it just sets them up for failure. The way to help people is to meet them where they are, acknowledge the real limitations of their life and set them up with a program or plan that’s sustainable and supported.
Is it fair to say that everyone defines health differently?
Step one in the book is to define what health looks like for you; if you don’t, it’ll be defined for you. Your doctor will tend to define it as a set of lab tests, and not dying, while the wellness industry will define it for you as having a certain, protocolized diet, routine, appearance or body weight.
You have to define what it is that you want and why. What do you want to be doing a year from now? How do you want to feel? Maybe you don’t want to lose weight and are willing to have borderline high cholesterol and take Lipitor for that. Maybe you want to do everything you can do to lose weight, so you’ll get up earlier to go to the gym and get less sleep. Everybody has the right to have different values and goals for their health; the problem is that people often don’t have the information they need.
How would you advise people to get the best out of the medical system?
First, take the time to examine yourself. Ask yourself questions that your doctor doesn’t have time to ask. Do that in advance, so that you’re able to connect the dots between your sleep and your stress, between your eating habits and your blood sugar, between your relationship with your mother and your relationship with medical authorities.
Have a document that lists all of your medications, past medical history, allergies and family history; keep it updated, and bring it to every appointment.
You don’t have to impress your doctor, but you want to make sure that you’re getting your questions answered. Treat it like you would any other relationship: if you’re the kind of person who always wants more information, or is ashamed of their weight, or tends to stay up all night Googling, make that known to your doctor. That self-awareness can be really transformative for the partnership. Likewise if you acknowledge the doctor’s limitations: “I know you’re busy; here’s what I want to talk about today.”
What do you think patients need to help them in navigating the health system?
Many people have been bounced between doctors. They haven’t had someone make the link between their work stress and their relationship with food and their diabetes, for example, or their knee pain, Advil use and high blood pressure. We have failed people by not helping them connect the dots between those mundane elements of their health, lifestyle and habits.
It’s no wonder that 29% of Americans are now using ChatGPT or other LLMs for health advice routinely. I don’t blame them, because there are studies showing that these LLMs are providing more empathetic advice, even if it’s not correct: it’s quicker and faster and it seems complete. The problem is that LLMs are master answer-generators; you’re just getting more information, which can lead you down the wrong path. They don’t know how to ask the right question, while the patient may not know what their question is.
The art of medicine is surfacing that question. There’s no shortage of evidence to show that if your primary care physician really knows you, they can help you connect the dots between who you are, your problems and your life, and empower you with that information. You live longer, your outcomes are better and you save money.
The medical system largely treats mental and physical health separately. How can doctors and patients navigate that mind-body connection?
You see so much ire and anger online from people who are told by their GP “maybe it’s anxiety”, and feel dismissed. Sometimes there is actually something else at play, but anxiety does manifest in physical ways.
I think doctors often aren’t adept at countenancing things that cannot be measured with a lab test. They may not have had a lot of training in how to talk to people about emotional health. If anxiety is the root cause of your high blood pressure, stomach aches and jaw pain, my job as a doctor is to acknowledge the anxiety as its own animal and help you troubleshoot.
Even the most sophisticated patients don’t always know how to cope, especially if they don’t recognize anxiety as part of their issue. When a physician connects the dots between that and the patient’s physical health and offers solutions, it can be really empowering.
Many people are pursuing diagnoses, tests or specialist help above the basic fundamentals . What does that approach miss?
There’s this notion that health is measurable in bloodwork or a Cat scan or a full-body MRI. The truth is that health is dynamic; it’s a process. You can be very unhealthy and still have a completely normal MRI scan.
Lab work matters, and people like looking at their results, but data without context is just numbers on a page. For example, I might have a patient with a “bad” cholesterol level of 102, when the ideal is under 100. The lab will flag that as high. If they’re 65, with advanced coronary artery disease and diabetes, that actually is too high and they need to be on a statin. But if they’re an active 25-year-old with no heart disease, that may mean they just need to cut back on cheeseburgers.
What role does the wellness industry play?
Along with the obvious pseudoscience, it’s peddling this illusion of certainty, suggesting that if you just optimized your glucose and meditated and ate this ideal diet, you would be healthy.
I’m not saying that the wellness industry is all bad, or that the things it typically focuses on – like sleep and exercise and nutrition – aren’t important. They are, but they’re not sufficient for health: you can meditate and have normal blood sugar, and still have depression, diabetes or cancer.
It peddles this notion that willpower guarantees outcomes, and if you just focus on the things you can control, you’ll be OK. There’s that very American, rugged individualism – but health is about genetics, luck, wealth and things you can’t measure.
Some of these supplements can do real damage – it’s not just wasted money.
Lots of supplements probably won’t do physical harm, but again, the notion that a pill is going to do the work for you can be pernicious. I’ve had many patients take Saint-John’s-wort because they’ve read that it helps with depression, when what they really need is a psychiatrist and standard treatment.
Related: Are you taking supplements correctly? Here’s a guide on their dosage limits
Supplements can also interfere with your organ systems. I’ve seen people with liver failure from supplements containing green tea extract. People may read that vitamin D is good for them, so they think “if one is good, I’ll take five”, then hit toxic levels.
In the modern world, it’s not easy to be healthy. How should people approach health, given all those challenges?
It’s about abandoning this notion that you’re going to optimize every part of you at once, and instead recognizing your particular pain points and priorities. Is it to manage your blood sugar better, to prevent or treat diabetes? Is it to lower your blood pressure, and feel more calm in life?
Instead of trying to do better in everything, get specific about your top health goal – whether it’s something your doctor recommended, or something you want for yourself – and figure out the realistic, sustainable changes you can make towards it.
Give yourself permission to be human, and do the best you can. We have to abandon this idea that you have to be optimizing everything, all the time. That’s really for wealthy, privileged people – for the rest of us, it’s just not realistic. You can’t organize your day around grams of protein. We have other things to think about.
Beyond the Prescription: A Doctor’s Guide to Taking Charge of Your Health, by Dr Lucy McBride (Simon Element), is out now in the US
Over 25 years of practicing medicine, running a primary care practice in Washington DC, Dr Lucy McBride has seen patients struggle to navigate the medical system.
This report is published with credit to theguardian.com. Full available text from the wire is above. Read on theguardian.com →
Source: theguardian.com · Elle Hunt. Published 27 Aug 2026, 04:00 pm.
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