Stepping Off the Slippery Slope
By Gray Ellrodt, MD - Published in the Berkshire Eagle, August 17, 2015
Let’s call our patient Joe. He may not know it yet, but Joe is standing on a very slippery slope. Like many people in late middle age, Joe is suffering from chronic health issues that keep him from thriving.
His illnesses have already cost him quality of life. They may also shorten his days. Joe thinks this is inevitable; everybody is going to get sick someday.
It is at this point that physicians like me start seeing a lot of Joe. Traditionally, we focus on people with complicated issues, whose symptoms have advanced to disease and the need for hospital care. And like many of my colleagues, I wonder how different Joe’s life would be if we had intervened years earlier.
There are a lot of people on the same path down the slippery slope. According to national health statistics, one quarter of older adults have at least one chronic disease like diabetes, high blood pressure, heart disease, and COPD (chronic obstructive pulmonary disease.) Of that 25 percent, half of them are suffering from more than one health issue.
Here is the most alarming statistic of all: seven out of 10 deaths in the U.S. are the result of chronic illnesses, and many of those lives could have been saved with evidence-based interventions. The problem is, our system of healthcare has traditionally focused on treating people after they get sick. It’s time to radically shift our focus to promoting health and wellness before people get sick, or with deliberate interventions that help halt the progression of disease after they become ill.
The most obvious place to begin ensuring a healthy future is when people are young, well before symptoms first appear and disease ultimately takes hold. But conclusive medical evidence proves that lifestyle interventions at any point along the progression of chronic illness will help. While sooner is always better, if Joe begins physical activity, eats a steady diet of nutritious food, and receives compassion and support for necessary lifestyle changes, he will regain a better quality of life - and even add years to his life.
We can help Joe step off the slippery slope, but the process can be complicated. Patients with chronic illnesses need physicians to diagnose and treat their disease. But they also need education, information, resources, and help with lifestyle changes to ultimately get better. Often, that kind of assistance is found in community organizations that focus on nutrition and exercise, or those dedicated to such chronic conditions as diabetes.
For example, patients diagnosed with high blood pressure – a widespread chronic illness that can lead to many life-threatening conditions – will probably receive medication from their doctor. But we know from evidence-based research that a prescription is not enough. Patients must also understand how to monitor their blood pressure and how to adjust diet and lifestyle so that their overall conditions improve. This requires the kind of time and vigilance not available from most primary care physicians who have practices that are already over-burdened with too many patients.
The challenge for healthcare in the 21st Century is connecting patients to all of the best medical and community resources available, creating dynamic partnerships that will share treatment and follow-up care for people with chronic illnesses. Massachusetts is already launching physician/community partnerships and other states will soon follow. While still in the early stages, this new model for the delivery of effective healthcare is showing great promise.
This is important work for all communities. People don’t want to be sick. For many of us, regaining quality of life and preserving precious years requires coordinated help from a variety of resources. These are the kinds of proven interventions that will keep people from getting too close to the slippery slope before their time.
Gray Ellrodt, MD, is Chief Quality Officer and Chairman of Medicine at Berkshire Medical Center.