It is important for us, as health care providers, to sometimes pause and reflect on the way we each practice medicine. In our busy lives, it is a challenge to completely address all the needs of every patient, but we need to do the best we can to address the things that will benefit the patient the most.
According to the Centers for Disease Control, over 80% of health care spending in the United States is for chronic diseases; that amounts to over $2 trillion annually. Seven of the top 10 causes of death in the United States are from chronic diseases, with heart disease and cancer together accounting for almost 50% of all deaths.
These numbers are staggering. Our health care system is not set up to handle chronic diseases, but is very efficient in an acute care situation.
Doctors and health care providers need to focus, with each patient encounter, on turning off the faucet rather than mopping the floor, as the immediate past president of the American College of Cardiology Kim Allan Williams, Sr., MD, MACC, FAHA, MASNC, FESC, and others in the prevention arena have emphasized.
Here is how it goes. The sink is turned on and the drain is plugged. The sink starts to overflow, spilling water all over the floor. We, as health care providers, tend to just mop the floor. When the blood pressure goes up, we give an antihypertensive medication. When the cholesterol is high, we give a statin. When the blood sugar goes up, we give medications for diabetes. All of this is mopping the floor.
Then, a patient has angina symptoms. He or she flunks a stress test, a severe blockage in the coronary artery is detected, so coronary stenting is done. Mopping the floor. The individual suffers a transient ischemic attack, or TIA, a few years later, so anti-platelet therapy is given. Mopping the floor. The sink keeps overflowing, spilling more and more water onto the floor, and eventually we just are not able to keep up. The patient dies of a preventable chronic disease.
The very first moment the sink starts to overflow, what should we do? Turn off the faucet, of course. If you just turn off the faucet, there will be no water overflowing onto the floor, and no mopping will be needed.
What is the faucet in this analogy? The diet and lifestyle of the patient. According to the World Health Organization, 80% of heart disease is preventable through lifestyle changes. Many believe this number is much higher — close to 99%. Only a very small percentage of heart disease is purely genetic. Often times, when someone thinks heart disease runs in their family, we find that unhealthy lifestyles also run in the family.
Doctors are not traditionally trained to turn off the faucet. Personally, I did not receive a single lecture in nutrition throughout my entire medical training. I did not get any education on how to discuss lifestyle changes with patients or how to give them the proper tools to be successful. Diet, exercise and weight loss just were not emphasized at all in my medical training.
It really bothers me that the disease I was trained to treat is caused by poor diet and lifestyle choices, yet I have had no clue how to address the diet and lifestyle of my patients. After years of just mopping the floor in my practice, I took it upon myself to learn nutrition, exercise and weight loss strategies and how to motivate my patients to be successful.
I challenge you to focus heavily on turning off the faucet. The majority of each visit should be on helping patients be successful with lifestyle changes. Make sure the patient knows the cause of their disease. I clearly communicate each patient with heart disease that the cause of their condition is diet and lifestyle, and therefore the treatment should be diet and lifestyle — not just drugs. Too often, doctors ignore this discussion, and patients believe that their health is out of their control. Actually, the opposite is true. A patient has the ultimate control over how healthy he or she will be for the rest of his or her life. But we have to educate patients on this and give them the tools to be successful.
Do not make the mistake of thinking that patients with heart disease will not change their lifestyle to treat their condition. That is like an oncologist just assuming that patients will not take chemotherapy to help treat their cancer. Diet and lifestyle — essentially the cure for heart disease — must be discussed with each heart disease patient at each visit. Then, you will be turning off the faucet rather than mopping the floor. – by Steven Lome, DO, RVT