Saturday, January 12, 2013

What Doctors Can Do To Improve Patients’ Health
Ask not what your doctor can do for you, ask what you can do for yourself?
Variation of President John Kennedy’s famous statement at his inaugaration “ And so, my fellow Americans,ask not what your country do for you, ask what you can do for your country, “  January 20, 1961

January 12,  2013 -  What can doctors do to improve the health of their patients?  Answering  this question could prompt a long and windy discourse.  
I shall be brief.  
 I went to my primary care doctor recently, and he said to me, “It’s not what I can do for you, but what you can do for yourself.”  He advised me to lose weight,  to eat a low carbohydrate diet,    to walk 15 to 30 minutes a day,  and to go easy on the vices – overeating, overdrinking, and overindulging in any other way.    He said to be practical on the exercise – walk around the mall or the big-box store, and on the psychological side, to maintain my social network,  and  to be happy and optimistic.
We did not talk about national reform fixes,  paying primary care  doctors more,  substituting generic for  brand name drugs,  reigning in renegade health plans,  dampening the profit of medical companies,  correcting the inefficiencies of 3rd party bureaucracies,  reforming the tort system,  giving patients ore information on risks and benefits of procedures,  installing electronic health systems,   encouraging health savings accounts,  bewailing the broken promises of Obamacare, complaining of  medical or national politics,  preventing or controlling the big five common  problems – diabetes, hypertension,  heart disease, depression, and cancer,   fixing the fragmented health system, developing integrated, coordinated,  comprehensive care,  thinking outside the box, or redesigning physician practices.  although we both knew these things were important.
If I had had the time, I would have liked to talk about the diversified American culture – with its rich mix of different ethnic groups and effects of poverty and lack of education.  

 I would have preferred to dwell more  on our open, capitalistic  society and its emphasis on freedom of action and of choice,  its high rate of accidents, violence, homicides,  and drug misuse  and alcohol addictions and the inability of physicians and hospitals to control what goes on outside physician offices and hospitals. 

I would have chosen to speak more on our country's great eras a country than other countries on treating hip and knee problems,  repairing damaged hearts,  bettrer  controlling hyperlipidemias, diabetes, and hypertension, .    I might even had noted our stellar record as a country of medical technologic inventions and of returning individuals to full productive lives.

There are certain things that doctors heretofore could not do,  like help poor patients obtain social services once they returned home or left the hospital when these services may be desparately  needed (Harlan Krumholz,"Post-Hospital Syndrome - An Acquired, Transient Condition of Genralized Risk,:NEJM, January 10, 2013).  But as doctors we can try.  The Physicians Foundation,   has issued a $1 million grant to Health Leads, a Boston-based non-profit, to recruit and train college volunteers in six major cities, to supply social services - job training, medical transprotation, medical advice, and home visits - to the poor once they have returned home. Doctors can now "prescibe" these services to the poor at the point of care before patients leave the home or the hospital.
Tweet:  What can physicians do to improve the health of patients?  We can remind them it’s what they do for themselves not what we do for them.

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