Be Fit For Life

with Ellen Cohen-Kaplan

Incremental medicine: an idea whose time has come

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An interesting article by a Newton surgeon and writer, Atul Gawande, has a lot of implications for how we live and take care of ourselves. Our Western-focused medicine exalts the virtues of surgery, cortisone shots, quick fixes and medication to silence symptoms of our various ills. What if we took our time, monitored our symptoms and tried to find the sources of our medical issues with a trusted, long term partner in health?

Gawande’s assertion, after observing, talking to, and witnessing several methods of health care delivery, is that care which is done with the whole patient in mind, over a period of time is most effective in helping all kinds of health problems. Primary care physicians are at the helm of this large and unsteady ship. Although they are paid the least, and perhaps respected less than specialists, they are positioned to make the most difference in the lives of their patients. This philosophy is not rocket science, of course, and this is exactly the point. The people who’ve known you for many years as a person with different facets, are often in the best position to help you stay healthy over time. Witness the difference in mortality between people with partners and those without. There is a sizable gap in years of typical ages of death between the two. Often, an objective person who knows you can advise you best about your health.

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The difference can clearly be seen in those communities with the best ratios of primary care physicians to the general population. For instance, various studies in the UK, Spain and California have shown that in areas where health care reforms improved primary care access, mortality rates fell and fewer hospitalizations were needed, resulting not only in improved quality and quantity of life, but lower costs.

“We have at least four kinds of information that matter to your health and well-being over time: information about the state of your internal systems (from your imaging and lab-test results, your genome sequencing); the state of your living conditions (your housing, community, economic, and environmental circumstances); the state of the care you receive (what your practitioners have done and how well they did it, what medications and other treatments they have provided); and the state of your behaviors (your patterns of sleep, exercise, stress, eating, sexual activity, adherence to treatments).” This is a wealth of information that can serve as the foundation for assessing the health of the whole person. The way it is used can make the difference between emergency care and ongoing   incremental steps to maintain wellbeing.

For instance, let’s say you go to the doctor with abdominal pain. How much of a history does the doctor take? How much time does he/she take to hear about your life at that point? Does he/she dismiss you within 5 minutes with a prescription for an acid reduction drug or a battery of tests to determine the potential cause? None of these actions are wrong, but they ultimately may not get to the root of the problem. Keeping a log of your belly-distressed times may help.  Attending to what you eat before you have the pain will give clues.  Questions about one’s living situation, family history,  sleep patterns, nutrition,  stress levels, and how they’re interrelated gives a more complete view of a person’s life, and hence their overall wellbeing.  These are the kinds of questions that a long term primary care provider may ask.

A major game changer is the fact that if you know your physician or health care provider well, you will seek help sooner for symptoms, so you’ll avoid getting more severe and potentially harmful health problems. The focus shifts from rescue medicine to lifelong incremental care.

The same can be said of managing basic joint and muscle aches and pains. If you take care of them early by paying attention to them, doing regular stretching, yoga, strengthening exercises, and avoiding the pitfalls of excessive sitting and inaction, you can positively impact your energy levels and productivity and quality of life. If you take incremental action by getting into a regular regime of healthy eating, a consistent exercise program, and dealing with issues as they come up instead of when they become disabling, you’re more likely to pre-empt major and potentially more intractable problems.

As models of health care delivery are in flux, it’s all we can do to be our own best advocate and do some of our own incremental care by being mindful of our eating, sleep, stress levels, and seeking advice early on when we see changes in our health and consulting with a trusted adviser on how best to manage it. What measures are you taking to care for yourself  and what kind of partnership do you have with your health care providers?

For all our insight into our bodies and its functioning, Gawande states that we can all be seen as “existing conditions just waiting to happen”.  What this means for our system of health care delivery remains to be seen.


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