Americans spend $5 trillion per year on healthcare, more than any other country on the planet. Spending that much, we ought to be the healthiest country in the world. Yet we continue to dramatically underperform.
While there are many reasons for this, one that doesn’t get talked about enough is our society’s view of what medical care should actually entail. The problem, according to David Rakel, MD, is that the American healthcare system is capitalistic: it makes money by treating disease.
Of course, there is nothing wrong with making money, but it can easily incentivize the wrong behavior. If more disease equals more money, then paradoxically, keeping people sick is better financially for the medical industry.
There is a better way to care for your patients—one that focuses on whole-person health, not treating them like a list of symptoms.
Research shows that meaning, purpose, patient connection, and perception have measurable physiological effects. They can often be more powerful than supplements and dietary protocols.
This is the focus of Dr. David Rakel’s Kharrazian Institute Master Class, Pills and Protocols: The Roots of Salutogenic Science. You will learn how to transition your practice from disease management to health creation and discover evidence-based principles that should be taught in medical school but aren’t.
Pathogenesis Versus Salutogenesis
We know that no doctor actually thinks in these terms, but at a system level, this truth still plays a major role in what medical care looks like in the US. It’s a major driver as to why the healthcare industry as a whole is focused on disease management, not health creation.
Another way to talk about this involves using the terms pathogenesis and salutogenesis. Pathogenesis combines the prefix patho-, meaning having to do with disease or suffering, and the root word genesis, dealing with the origin of something. Thus, a pathogenetic view of medicine focuses on the origin of suffering.
Salutogenesis, on the other hand, comes from the same root word, genesis, but attaches a different prefix, salut-, relating to good health. A salutogenetic view of medicine, therefore, focuses on the origin of health.
As it turns out, which view of medicine you take has a huge bearing on patient outcomes. A healthcare system built on pathogenesis will focus on finding and managing disease. One built on salutogenesis will focus on finding ways to create health. Which system would you rather receive care under? Your patients probably feel the same way.
Why Our Current Healthcare System Focuses on Pathogenesis
Most clinicians operate exclusively in a pathogenesis model. We identify symptoms, order tests, and prescribe interventions—and we’re very good at it. But we’ve largely abandoned salutogenesis. We become laser-focused on symptom management, which creates a gap in understanding what creates health and resilience. But why is this so?
One aspect of this has to do with medical training. Modern medicine is truly wonderful; it has saved countless lives and improved countless more. But, unfortunately, doctors are trained to look at patients through the lens of “what is wrong.” However, that’s only half the battle, says Dr. Rakel. It’s also critical to consider “what is right.” If you don’t, your patients may not get better, and you may slowly burn out trying to manage symptoms instead of facilitating healing.
Additionally, as mentioned above, our current healthcare system is built on a financial model that profits from treating sickness, rather than from promoting wellness. Dr. Rakel describes the typical hospital as a “disease trap,” where the underlying business model makes money by performing more interventions. Keeping people sick, or at least running more tests and prescribing more drugs, is incentivized because it leads to more profit.
In this scenario, if you are an individual medical practitioner who wants to focus on creating wellness, you may be swimming upstream, challenging assumptions built into the system that others may not even perceive. But there are still things you can do.
Did you know?
- Most metabolic dysfunction can be reversed through lifestyle changes—without medication.
- People with meaning and purpose in their lives are 2.5x less likely to experience premature death.
- Your presence in the examination room is one of your most powerful clinical tools, yet most doctors never learn to use it to their advantage.
For 30 years, David Rakel, MD, has been asking a question most clinicians never ask: What if we understood the science of creating health instead of just treating disease? His Kharrazian Institute Master Class, Pills and Protocols: The Roots of Salutogenic Science, distills his three-decade journey into clinically applicable strategies you can implement in your next patient encounter.
How to Focus on Salutogenesis in Your Practice
Perhaps the most important change you can make as a practitioner is one over which you do have some measure of control: You can begin to transition from transactional care to transformational care.
What does this mean in practice? Instead of defaulting to operating on the principle of a “pill for every ill” or one generalized protocol after another, begin to approach each patient you see as a whole person, not just a list of symptoms. Sit down and listen to their story. Find out their health goals. Commit to partnering with them to achieve these goals, rather than solely focusing on numbers and data.
Is this hard, given the high-throughput model of many healthcare facilities? Yes. But it is also worth it.
Mount Kilimanjaro and Hemoglobin A1C: a Salutogenic Success Story
Dr. Rakel tells the story of a female patient, aged 49, who challenged her doctor to make the switch from pathogenetic (transactional) to salutogenetic (transformational) care in her practice.
This patient had type 2 diabetes. She came into her doctor’s office every few months to have her hemoglobin A1C and LDL cholesterol checked. And she would leave feeling defeated, even shamed, for failing to meet the expectations of the healthcare system. The message was always the same: You’re not losing enough weight. You need to eat better. How much are you exercising?
Finally, she went in to see her doctor and said, “I don’t care so much about my hemoglobin A1C or LDL cholesterol. I’ve always wanted to climb to the top of Mount Kilimanjaro. Help me do that.”
Initially, the doctor resisted, but he eventually decided to give this approach a try. Together, they came up with a plan for the patient to achieve this goal. The plan included meeting with a psychologist to boost her confidence and consulting with a nutritionist, in addition to continuing her regular physician’s visits.
The result? A year later, the patient stood atop Mount Kilimanjaro, ecstatic that she had achieved her health goal. And to her doctor’s great satisfaction, her A1C numbers went down too.
Dr. Rakel cautions that this is a “perfect story”—things don’t always happen that way in a salutogenic model of care. There is still messiness in being human. But he does like to tell this story because it shows the potential of what doctors and patients can achieve when they shift the conversation from symptom management and behavior modification to achieving health goals.
Beyond Pills and Protocols: The Roots of Salutogenic Science with David Rakel, MD
Dr. Rakel has spent a career diving into what makes medical care good, seeking to discover the secrets of care that do the best job of improving patient health outcomes over time.
What he found was that many of the things that actually matter don’t get taught in the classroom. Medical school curricula too often focus on identifying and treating symptoms, not creating health.
Now he is sharing what he has learned with you in his Kharrazian Institute Master Class, Beyond Pills and Protocols: The Roots of Salutogenic Science. This five-hour online course distills Dr. Rakel’s decades of clinical experience into an applicable framework for shifting from pathogenic to salutogenic medicine.
When you attend this master class, you’ll learn:
- Decision-making that serves patients instead of protocols
- How belief becomes biology through neuropeptide cascades
- Why your presence is often more therapeutic than your prescription
- How to intentionally create healing encounters that activate meaning, purpose, and self-healing
Don’t miss your chance to learn how to shift your practice from disease management to health creation. Register today.
Frequently Asked Questions
What is salutogenesis, and how does it apply to clinical practice?
Salutogenesis is an approach to medicine that focuses on the origins of health rather than the origins of disease. In practice, this means identifying the biological, psychological, and social factors that help patients build resilience and well-being.
How is salutogenic care different from the standard disease-management model?
Traditional medical care is largely pathogenetic—it focuses on diagnosing disease and managing symptoms. Salutogenic care still addresses pathology, but it also emphasizes meaning, purpose, lifestyle, relationships, and patient engagement as drivers of health.
Can a salutogenic approach fit into a busy clinical practice?
Yes. Asking patients about their goals, listening to their story, and framing care around what creates health can change the clinical encounter without dramatically increasing visit length.
How can practitioners learn to apply salutogenic principles more intentionally?
Most clinicians were never formally trained in the science of creating health. Dr. David Rakel addresses this gap in his Kharrazian Institute Master Class, Beyond Pills and Protocols: The Roots of Salutogenic Science. In this course, you’ll learn practical, evidence-based ways to incorporate salutogenic principles into everyday patient care and transform routine encounters into opportunities for healing.
