The Upstream Doctors

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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, perhaps fatally so. 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 strongly argues that that the future of our health, and our health care system, depends on growing and supporting a new generation of health care practitioners 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, rather, that health begins in our everyday lives, in the places where we live, work, eat, and play. Upstreamists know that asthma can start in the air around us or in the mold in the walls of our homes. They understand that obesity, diabetes, and heart disease partly originate in our busy modern schedules, in the unhealthy food choices available in our stores, and even in the way our neighborhoods are designed. They recognize that depression, anxiety, and high blood pressure can arise from chronically stressful conditions at work and home, and that such conditions can even affect our DNA. And, just as important, these medical innovators understand how to translate this knowledge into meaningful action. If our high-cost, sick-care system is to become a high-value, health care system, the upstreamists will show us the way.


"Rishi Manchanda’s TED Book about upstreamists breaks a lot of new ground. His is a novel and compelling vision that moves prevention front and center in medical care by moving the doctor upstream — upstream to where the problems begin and where a little insight and foresight can convert an oncoming medical disaster into a preventable problem." — Fitzhugh Mullan, MD , Murdock Head Professor of Medicine and Health Policy, George Washington University School of Public Health, and Clinical Professor of Pediatrics at the George Washington University School of Medicine

"This book is fabulous. As an upstreamist, Dr. Manchanda knows that without addressing the social ills that are the source (the upstream causes) of the patients' medical problems, those problems will never be adequately solved. In his book, and in his work, Dr. Manchanda presents an uplifting and necessary journey for any of us who think narrowly as downstreamists." — Thomas S. Bodenheimer, MD, MPH professor, Department of Family and Community Medicine, and director, Center for Excellence in Primary Care, University of California at San Francisco