Helping patients learn to help themselves

February 25, 2013

Stressing the benefits of healthy habits to your patients rather than ordering tests or referring out can help you focus your practice on what interests you most, too.

 

Jeffrey K. Pearson, DO, is a board-certified family and sports medicine physician in private practice in the San Diego, California, region. He is a member of the editorial board of Medical Economics and served on editorial board of a Medical Economics’ former sister media brand, Patient Care, for many years. Pearson is affiliated with the teaching programs of several medical schools. In 1992, he was the physician recipient of the Patient Care Award for Excellence in Patient Education, sponsored by the American Academy of Family Practice and the Society of Teachers of Family Medicine.

Here, he interviews Wayne Scott Andersen, MD, the co-founder of Take Shape for Life, a division of Medifast. In 2008, the hardcover version of Anderson’s Habits of Health, was published. In it, he describes how individuals can achieve optimum health.

(Full disclosure: In 2012, Pearson lost 60 pounds on the Take Shape For Life program after reading about it in Medical Economics. He is a health coach for his patients.)

Pearson: You spent 20 years practicing in the field of critical care medicine. In fact, you were one of the first physicians to be certified in this field when it became available. Why did you walk away from such a lucrative position?

Anderson: Let’s use the old analogy about the lifeguards working along a fast-moving river. Due to hazardous conditions upstream, as soon as one body was fished out of the river, another followed, and so on and so forth. The lifeguards were perpetually dragging dead bodies from out of the river without let-up. Working in critical care units is like that. We were treating the end-stages of many diseases-heart failure, diabetes, and the like. As soon as one bed emptied, it was filled with somebody new. Thanks to the current American lifestyle, there is never a shortage of patients to fill a critical care unit.

I used all of the high-tech equipment and medications that were available to me to treat these diseases, but, alas, critical care work became quite frustrating. I did some research and learned a few things about nutrition. I found that when I focused on the basic needs of the human being (for instance, nutritional interventions such as branched chain amino acids), my critically ill patients started getting better. That was my first clue; in terms of long-term success, if we, as physicians, can get the body back into balance, patients do better.

Continuing with the analogy, I decided to head “upstream” to see whether I could prevent some of these medical catastrophes. It seemed that helping individuals achieve optimum health was the best way to prevent these all-too-common chronic disease states. The biggest (but not the only) obstacle for many people is dealing with being overweight or obesity. So, following sound medical principles, I started Take Shape For Life in 2001, and it took off. I’ve been able to have a positive impact on way more people than I ever could in the critical care unit.

Pearson: Obesity really does seem to be the key to many of the chronic problems with which we deal on a daily basis in our practices. What are your thoughts on how this all came about?

Anderson: We live in what I term an “obesogenic” world. Everything around us encourages us to do less and eat more. Individuals need to take an active role in their health. They need to become the dominant force in controlling their own health and their lives. For individuals to be able to do this, they need to be educated as to what are the key components. What is important?

We all must overcome the negative energies in our lives. After all, we live in crazy times. Most people are overwhelmed. They don’t know what is nutritionally sound for them. They learn little bits and pieces from magazines, but they don’t really know the whole package. My reason for writing Habits of Health was to teach people how to focus on all of the little baby choices that confront them on a daily basis, from how they move their body to how they eat, how they handle stress, etc. What are the little key things that they can do over time that can make all of the difference?

Most people look at health as this thing where they have to eat six, seven, or eight fruits and vegetables per day. They don’t get to do anything that they really want to do. They feel that they must avoid all of the things that bring them pleasure. And this really is not true.

What it basically comes down to is this: the majority of us gain 30 to 40 pounds of excessive weight because of the habits of disease. We live in a time where on average, if we eat 100 extra calories per day, we gain 5 pounds per year. Then, we reach middle age with this “little rotunda” around our middle, and we don’t know how to get rid of it. We try things, we restrict ourselves, but there is really no long-lasting benefit from it.

What we’re about is changing that orientation to focusing on how to create health in your life. It’s a fundamental shift from “What am I trying to get rid of?” to “What am I trying to create?”

Pearson: It seems that for many doctors, preventive medicine only means performing screening laboratory tests and treating conditions that have already developed. Shouldn’t we, instead, be imparting knowledge?

Anderson: That’s true. Sure, we can tell patients “Your biomedical markers reflect that you’re at high risk, and we can put you on medicines.” But we really need to intervene sooner than that.

The problem is that we’ve gone from 12,000 ICD codes to more than 150,000. We are literally creating more diagnoses and creating more solutions for them. Things have gotten way out of control. In terms of infections or immunizations, those things are great; we’re very good at dealing with external invaders. But as far as dealing with the inside of us, as a profession, we’re lacking.

As physicians, we need to teach our patients how to make the types of lifestyle choices that support long-term health. And the thing is, it really isn’t this overwhelming task. It’s about simplifying, “dumbifying” it down, where people realize that they can learn to create a healthy weight. And, more important than that, by making some relatively small changes in their daily choices across the full spectrum, they can actually create long-term health in their life.

Pearson: How can primary care doctors help with this?

Anderson: As primary care doctors, you are trusted. You’re right in the middle of the battle. When patients come in, you have the opportunity to-and I hate to say this-either enable them by putting them on more statins or more antihypertensive medications, or you can say, “Listen, fundamentally, Sally or Sam, let’s focus on how we can work together to create health.” We need to be partners with our patients rather than an authoritarian that gives them orders (“You need to do this,” etc.). If we partner with our patients and start acknowledging why they struggle, rationalize what they really have to do, then spend the time and really invite them to move forward and do the things that are necessary, we can make a dramatic difference in their health.

Pearson: But what about a family doctor who’s seeing two patients every 15 minutes? It’s much easier for them to simply order the tests and deal with them.

Anderson: That’s absolutely true. The unfortunate reality of modern medicine is that we have very little time. The sad truth is that 50% of family physicians are really stressed. They’re overwhelmed. Many of them are depressed. They’ve forgotten the joy of medicine. Most of them entered into this profession to help people and, now, instead, they have this burden. And so we need to fundamentally change this system.

Once physicians learn how to help patients create health and be partners where they [the patients] take an active role, then suddenly that whole relationship shifts. It ceases to be the one where you have the burden of being this person from high above whose job is to lecture them. Now you partner with them. If you’re willing to do that and understand this principle, then you can then really make a difference in their lives.

We now have more 3,000 physicians involved in the Take Shape For Life program. This is not just a weight loss program, by the way. Rather, our goal is to help our patients achieve optimum health. It’s much easier, however, to achieve this when they can lose weight in a fast and safe manner. The physicians in our program are very capable, and they’re moving people forward. And you know what’s really great? These physicians tell me that they’re favorite part of their day is when that patient comes in and gives him or her a big hug and says, “Thank you. I’ve lost weight, I’m getting healthy, and I’m off of two medicines. Thank you, doctor, for being part of that.”

Pearson: A few years back, I personally made changes in my practice. I made a conscious decision to see fewer patients each day to spend more time with them to educate them on their health and make the visits more effective. It’s my own private practice, so I can pretty much do what I want.

However, many of my colleagues are under a time crunch (self-imposed or otherwise) where they need to see so many people a day. It’s become easier for them to refer patients out for things that they‘ve been trained to do, simply for expediency’s sake. Some examples include referring patients out for pulmonary function tests instead of doing spirometry in their office, or sending patients to a dermatologist to remove suspicious skin lesions because they don’t want to take the time to do this themselves.

When it comes down to teaching healthy habits, their response often is, “Well, I don’t have the time to do that.” I suspect that this is one of the driving forces behind the growth of midlevel providers such as nurse practitioners and physician assistants. It certainly would be nice if doctorss felt that they were getting reimbursed for healt, rather than for treating disease. (Of course, this is theoretically the basis for the HMO practice model: physicians who keep their patients healthier see them less and get to keep more of their cap monies.)

Anderson: Most people don’t understand nutrition. They don’t understand portion control. They don’t understand low glycemic index. So one of best things that I did a decade ago was to partner up with Medifast. Within their system, I created the concept called Take Shape for Life. With this, it allows patients to raise their hands, say, “I want to get healthy. I need some tools to help me achieve my goals.” And now, for the same cost as their regular food, they can now use these meal replacements to move forward and put health in their life. And with that, we now have more than 3,000 physicians across the country that have now become part of Take Shape for Life. What they do is to help their patients get healthy and they get paid handsomely for their efforts.

What this does, to get to your point, is that it gives physicians the opportunity to spend more time with their patients and get compensated fairly for their time and efforts toward helping them get healthy. It gives these physicians the opportunity to really do what they want to do. They don’t want to move people through like a paper mill. They don’t want to do this thing where they’re merely reacting to disease-to put more medicine into the machine, so to speak. They want to help their patients get and remain healthy. And so we’ve created a mechanism that allows them to do that.

Pearson: How do you see medicine evolving in the future?

Anderson: This bears repeating. One of the things that has to change is the relationship from [physicians] being the authority to being partners. If you really ask your patients what they want, they want to be healthy; they want to live a longer and stress-free life. That’s very different than reacting to disease.

I look at the history of medicine in three eras. The first era was from Hippocrates to the 1950s. We focused on public health issues, infectious disease control, and the like. Look at the success we had at eradicating small pox. So a lot of great things happened early on. But over the course of the past 50 years, we’ve been looking to use technology to help our patients to get healthy, and it just isn’t working. More people are overweight or obese. This has become particularly alarming in our nation’s children, where nearly one in five is now obese. The level of strokes between ages of 24 and 35 has more than doubled over the past 10 years. We are literally less healthy, both medically and psychologically.

What we have to do is to move medicine on to a third era. Our patients trust us; they need us to be their advocates. We need to be their partners to move them forward to help them create long-term health. This is fundamentally a very sound concept. It’s what primary care physicians are supposed to be doing all along. There’s no doubt that we’ve gotten better about making our drugs safer-we have good monitoring systems for blood levels, for example-but still, drug therapy is not anywhere nearly as safe as lifestyle management.

The Cleveland Clinic looked at this a few years ago and concluded that when you help people restore or create healthy weights and make healthy choices, they were often able to get off medicines and avoid surgeries and hospitalizations. This is totally safe, that is, without side effects. We physicians need to be the centerpiece of that.