January 15, 2015 – Many people believe that the health care system in the United States is broken – that it’s driven more by the policies and profit margins of insurance companies than providing quality, individualized care to patients.
Dr. Stephen Schimpff, retired CEO of the University of Maryland Medical Center, author and one of the world’s foremost experts on health care, recently spoke to future residents of The Lutheran Village at MILLER’S GRANT in Ellicott City about how the relationship between doctor and patient has changed over the past couple of decades, and changing this relationship can offer health care providers the opportunity to provide better care and patients the opportunity to age more gracefully, and healthfully.
Most older adults have multiple physicians who prescribe multiple medications. Some of these medications, if not carefully coordinated, can react with each other and can cause additional problems that then also need to be treated. For example: many high blood pressure medications will cause erectile dysfunction in men, which then requires an additional prescription to treat.
Dr. Schimpff used his friend “Henry” as an example of the common experience an older adult today has with the health care system today: Henry has limited physical activity and is in grief over the death of his wife. He is seeing multiple doctors and is taking 23 medications, including three for high blood pressure, two for heart failure, and two for diabetes, among other things. Dr. Schimpff believes there is a better way. After encouraging Henry to see one primary physician to coordinate his care, his medications were reduced to seven and he began feeling much better. “What we need is a single doctor who will spend time with you, time to listen, and sort things out,” said Dr. Schimpff.
Slowing the Aging Process
Today, for the average adult aged 60, life expectancy is another 21 years for men and 24 years for women (on average 81 years for men and 84 for women).
“After about the age of 35-40 years old, we start losing about 1% of function per year,” said Dr. Schimpff. He went on to say that the human body has huge redundancy – we can afford some decline without illness, but we eventually reach a point where disease presents itself. And, parts tend to wear out as well! The most common surgery for older adults is knee replacement.
For most people the things that normally decline as we age are vision, hearing, mobility, reflexes and balance, cognition and memory. Chronic disease also tends to be more prevalent in older adults – heart failure, cancer, chronic lung and/or kidney disease, and diabetes. “These aren’t necessarily diseases that occur because we’re older, but they occur when we are older,” he said.
In 1900 the top three causes of death were infectious diseases: pneumonia or flu, tuberculosis, gastrointestinal infections. Today, the top two causes of death are chronic diseases: cancer and heart disease. Dr. Schimpff said that most chronic diseases are lifestyle oriented and are preventable. Some may even originate early in life but not become an issue until later. For example: coronary artery disease may actually begin in childhood due to a poor diet or other lifestyle choices but won’t manifest itself until much later in life as a heart attack.
Goals of Preventive Aging
Dr. Schimpff said that there are several things we can do help to improve our physical health as we age:
Adopt healthy behaviors
- Exercise 20 minutes 3 times per week (start slow if you don’t exercise now)
- Get to an appropriate BMI
- Don’t smoke
- Make fruits and vegetable an important part of your regular diet
- Wear your seat belt
Only 3% of adult Americans responding to a survey said they adhere to all five behaviors. Many chronic diseases are caused by adverse behaviors such as poor nutrition, lack of exercise, chronic stress, and tobacco use.
Pay attention to bone mineral density
While this is an issue for both men and women, women tend to reach a fracture threshold before men as bone density tends to decrease faster after menopause.
- Get enough exercise
- Eat a proper diet with plenty of fruits and veggies.
- Consider taking a vitamin D supplement – we don’t get as much sun in this latitude, and, we’re too much sun exposure is bad
- Reduce stress
Cognitive aging can also be slowed as we age. Fight vascular conditions, metabolic syndrome and chronic stress by being physically active, intellectually challenged and socially engaged. Use your brain to slow cognitive aging – don’t just read a book, join a book club to challenge your mind.
Slowing the aging process
We can prevent the acceleration of the normal aging process, but we can’t stop it entirely. Early detection and treatment of age-prevalent disease is crucial, as well as taking preventive steps as early as possible.
- Avoid tobacco – it’s never too late to quit to achieve a health benefit
- Reduce chronic stress
- Eat a nutritious diet
- Do cognitive exercises
- Be physical active
- 30 minutes of aerobic activity five times per week
- Resistance or weights 2-3 times per week
- Balance 2-3 times per week
- Reduce stress
Being proactive is key to preventing age-prevalent disease.
- Get screened for risk factors such as blood pressure and cholesterol levels.
- Keep your immunizations up to date including flu, pneumonia, shingles and tetanus.
- Eat a proper diet – the Mediterranean diet is an excellent choice.
- Develop an individualized exercise program that includes aerobic, resistance and balance exercises.
- Get engaged in some activity to maintain cognition.
- Avoid environmental hazards – especially those that will cause trips/falls.
The Value of Comprehensive Primary Care
According to Dr. Schimpff, primary care physicians are now seeing twice as many patients per day as they did 20 years ago, largely due to low reimbursements per visit. Each patient usually gets a 15-minute time slot, which equates to 8-10 minutes of face time with the doctor. While he said this may work for a single, acute, simple issue, it is insufficient for chronic or multiple issues where multiple medications are involved. And, he believes short visits are not satisfactory for any patient, regardless of age, with anxiety or vision, hearing or cognition impairments.
A common misperception of primary care is that it is episodic – you only see the doctor when you have a problem, and only for simple things. In Dr. Schimpff’s concept of medical care, a primary care physician (PCP) can take care of 90% of most medical needs if permitted the time. They can handle episodic issues as well as manage serious chronic conditions, but it requires a close relationship between patient and doctor. The PCP will coordinate care when specialists are needed, will screen for chronic disease risk, will take measures to prevent acute illness (vaccines, etc.) and will encourage the patient to have a healthy lifestyle. A quality, comprehensive primary care doctor is well educated, committed to relationship-based care, and is proactive, listening to each patient, then diagnosing, treating and preventing based on the information gathered through this expanded doctor-patient relationship.
The latest innovation is Direct Primary Care – a membership-based system that some doctors are migrating to. For a monthly or annual fee (ie: $1,500 per month per patient) a doctor will reduce his/her practice size from 2,500 or more patients to 500. This allows for same or next day appointments, more time for the physician to listen and make individually based decisions to address each patient’s issues. These PCP doctors are available to their members 24/7 by phone and email. In this model, the patient, not the insurer, is the customer that the doctor caters to.
This model of care costs more up front, but provides better health and wellness, a better quality of care, and more satisfied patients and doctors. Dr. Schimpff adds that with improved overall health of individual patients, this model of care will in the long run offer a much lower total cost of care due to improved wellness, reduced number of medications prescribed and reduced hospitalizations.
Patients Have Responsibility, Too
That’s not to say the patient doesn’t have an equal responsibility in this relationship. “Yes, we have a right to health care,” said Dr. Schimpff, “But that right is balanced with responsibility.” That responsibility includes leading a healthy lifestyle and taking all medications as prescribed. With appropriate attention by both patient and doctor, it is possible to slow the aging process and avoid or delay age-related disease.
About Dr. Stephen Schimpff
Stephen C. Schimpff, M.D. is an accomplished physician, thought leader and author. His accomplished career includes positions as CEO of the University of Maryland Medical Center, Director of the University of Maryland Cancer Center, tenured professor of medicine, consultant to the U.S. Army and associate of the National Institutes of Health. Dr. Schimpff has written three books, six textbooks and more than 250 medical and scientific articles. He is a graduate of the Yale School of Medicine.
Copyright © 2014 Lisa Albin