I haven’t talked much about my personal life or what I do in my spare time. I like to lift heavy shit for time. AKA CrossFit. I’m really into being healthy and personal betterment, whether it is intellectual, physical or whatever. I was a personal trainer for a while before PA school, I’ve ran 10+ half marathons, I did one triathlon and played sports virtually all of my life. You get it–it’s important to me.
Being a health care provider can be somewhat frustrating at times for anyone who is health conscious. Most of the people I see and treat are super sick. They take 10-20 medications daily, have no idea what medications they are taking or purpose they serve. Most of you have probably experienced it on some level. I remember being super impressed with a 93 year old patient I had who could tell me when his last echocardiogram was and his ejection fraction. I may have high fived him, he pretty much rocked.
I think the overall state of our health is rapidly declining. I also think patients do not have a clear understanding of what is occurring with their health. Seriously though–as a Nation we are in bad health. Why is this happening? I believe there are innumerable reasons and road blocks. Some of which I am going to venture to explore today. All of the reasons are too complex to mention in one post-I’m sure I will touch on a lot of them as time goes on, as for now, I’ll leave it to what I believe are the massive red flags.
I can’t help but wonder if a false sense health and wellness is being created. What are the forces behind this potential false sense of health and wellness? Driving forces include health care providers, sensitivity and political correctness, the new average/normal health state of society, as well as screening tests and advanced technology inadvertently reassuring bad habits.
A substantial number of patients with chronic conditions that we know and treat are not improving. In fact from my experience it can be the opposite. Their diseases are getting more concerning, hemoglobin A1c’s are rising, ejection fractions are dropping and the number on the scale is going up. Consistently on my rotations I watched providers ignore the BMI, edit out “obesity” on patients discharge summary or simply just add medications or increase insulin regimen without talking to the patient about what was going on or why it was happening. Patients begin seeing medication as getting rid of their illness as opposed to masking it.
People no longer think they are diabetic because they take insulin, or that they don’t have high blood pressure because they take metoprolol. Instead of having important, difficult conversations with patients about their weight and other various aspects of declining health We slap medicine on it to fix the numbers. But, is the quality of life of our patients improving?
Now, let’s be clear I’m not shaming medical providers. However, suggesting that we do have a small part in perpetuating the epidemic of illness. That small part entails not succumbing to a ridiculous level of political correctness that we neglect to broach difficult conversations with our patients. We need to talk to our them about difficult topics and make sure explain that just because they are taking a medication doesn’t mean they don’t have a disease. I know we are all short on time it’s hard to cram all this stuff into a 15 minute appointment. What I do ask and suggest is that we don’t see it and brush it to the side because it’s “taboo” to help your patients hold themselves accountable. Talk to that patient who has put on 15 pounds since their last appointment. Tell the new patient who has a BMI > 40 that their weight is adversely effecting them, and if it hasn’t yet it will–warn them of the adverse effects. Heart disease, diabetes, stroke, joint ailments/chronic pain–all of which can lead to more damaging and expensive side effects.
Sick is the new standard. Yea, kind of like orange is the new black. Whether or not any of us want to admit it we are a culture that for most of us–we follow a general range of societal norms. What is average is normal, and the more people who are a certain way the more normal it is therefore the more accepted. When things are “acceptable” there is no sense of urgency to do anything to change. Meaning that because having multiple chronic diseases have become the norm, it is becoming very acceptable to simply just life with these diseases.
Diabetes. According to the CDC in 2002 5.5 million people had diabetes. In 2014 22 million people were estimated to be afflicted with the disease. The cost for diabetes direct and indirectly in 2012 was 245 BILLION dollars. That absolutely blew my mind. I asked my colleagues this same question and their responses were not even close. Their guesses included 2 and 3 MILLION dollars.
Obesity. An estimated 34.9% aka 78.6 million adults are reported to be obese. Ready for the cost annually? 147 BILLION in 2008. Again yes, BILLION. We wonder why our country is in a ridiculous amount of debt—–a post for a whole other day. The CDC reports that the medical costs for obese individuals are 1,429 higher per year than a person with a BMI WNL. Anyways, this is not supposed to be about cost.
Heart disease. Kills 610,000 individuals annually. Coronary Artery Disease (CAD)–which I swear every patient I admit has–kills 370,00 0 each year (for the love of god people take your Lipitor I don’t care if your muscles hurt–kidding kidding). Again, the modifiable risk factors that have the possibility of having a positive impact on patient morbidity and mortality if addressed are numerous.
Stroke. 800,000 hospitalizations in 1989 and that number is now up over a million. Cost per year in 2008: 18.8 billion.
I have simply highlighted several diseases that were easy access on CDC and that I know from clinical practice are incredibly common. The sad part about these diseases is that there are more modifiable risk factors as opposed to non-modifiable. Physical inactivity, obesity, smoking, medication compliance (one could argue if this is truly “modifiable” or not).
My point is that the numbers of chronic diseases are rising at a ridiculous rate. I would venture to guess that if you combined the category of overweight and obese individuals together they would comprise >50% of the population. I’m also willing to bet that >80% of hospitalized patients are either overweight or obese. I can’t remember the last time I palpated an abdomen of normal size. The madness needs to stop. People need to get off the merry-go-round. Providers need to start having difficult conversations. Patients need to start having accountability and the iron armor of political correctness needs to be sloughed off. I’m not saying bully people with chronic diseases. I’m simply suggesting we attempt to become catalysts for change instead of simply allowing our patients to accept poor health standards.
So, we are now led to the point where we have all of these chronic diseases that have quite the laundry list of potential negative effects. What do we do? Create a screening tool, which has positives and negatives.
Smoking for example. Smoking kills. We all know this, there’s this thing called the surgeon general warning. Because of this, in the health care field we have (and by we I mean the powers that be—The USPTF) decided that we should “preventatively screen” individuals 55-80 who have a minimum of a 30 pack year smoking history or have quit within the past 15 years. What we are doing for them is giving them a one time dose of low radiation CT scan to screen for lung cancer. There are results that can be found on the USPTF website if you want more information on the study USPTF LDCT Lung CA Screening. There are various additional links on this page you can click to read more about the screening and evidence to support this standard of care.
Now, my initial response was–what a great idea we can catch cancer early, less money spent on chemo, radiation and maybe show patients that yes–smoking does kill. However, there was an article published in a recent article of JAAPA suggesting that perhaps we are giving smokers a false sense of “it is ok to smoke” because so few of these tests are turning out to be positive. Meaning patients with a significant smoking history has the test completed and it comes back negative–what this translates to for a patient is this: ” Oh, well I smoke but I had my screening done and everything is ok so I guess I can continue to smoke”. There is question being raised if we are have created a phenomenon of false security. FYI the USPTF is reporting that there is clinical significance to benefit patients from performing he LDCT.
On a related note, we have a lot of different sophisticated measures these days that can track out calories, what we eat, how much energy we exert, etc. I’ve developed this notion in my head and I’m not sure who else shares this proposition with me, that devices such as fit bits also contribute to a false sense of health.
DISCLAIMER: I know very little to nothing about these devices. My extent of knowledge on them is that they electronically can track your steps, you can set up step goals, face off against your friends to see who does the most steps and that some of them claim to be a let o track sleep activity. Here is my beef. Say your step goal is 5,000 for the day and your work in a hospital. It’s very likely that you are able to get those 5,000 or more steps in your 8, 10 or 12 hour day. However, taking this many steps throughout the duration of time previously mentioned is not the same as someone who goes out and continually moves/exercises for 30-45 minutes. The person who gets their steps or activity in through 8-12 hours does not sustain an elevated heart rate to produce the same cardiovascular and metabolic benefits as someone who continually goes for runs, swims or does Crossfit, etc.
I’m not suggesting take the elevator everywhere and that walking wherever and whenever you can to keep moving is a bad thing. My point is that I don’t think it suffices to count for working out and I think a lot of people who use these devices can tend to be of the mindset that “oh I don’t need to go to th. gym/run/swim/Zumba or whatever it is you do because I walked 5,000 steps today”. I just cannot buy into this mindset and I think a lot of people do.
Why is this important? Less activity leads to more people being over weight and obese. Obesity puts more people at risk for multiple chronic diseases, diseases which are leading to the acceptance of our current state of health as a nation. We need to start with ourselves as providers by doing our best to institute change and provide support to our patients. In return hope that our patients are able to accept some sense of self responsibility, realize a change needs to be made and begin to take steps toward better health outcomes one person at a time.
I would love to hear what others think, drop a comment and let me know what you think!!