The Doctors Next Door

Healthcare Won't Make you Healthy

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Is it true?  Healthcare doesn't make you healthier?  Why that's blasphemy!

And alas... true it is.  Julie Deardorff and Judy Graham had an eloquent piece in today's Chicago Tribune that discussed just that point.  Truth be told, health is in fact influenced by factors in five areas of our lives. 

Here are the five things and the proportion that each contributes to premature death [McGinnis, et al.2002, Health Affairs]:

1. Genetics 30%--yea, go ahead, blame the parents

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Don't let those little smirks fool you

2. Social circumstances 15%--probably at least partly our parents faults too but at some point we have to take responsibility for our own circumstances

3. Environmental exposures 5%--here we're talking about things like lead paint, pollution, whether you live in a dangerous neighborhood, etc.

4. Behavioral patterns 40%--see yourself in this one at all... huh?


5. Healthcare 10% oh, I guess that one would be mine.  Phew! I only have to worry about 10% of the deaths.  What a relief, that can't be more than a few million.

Yes, despite all our bickering over the healthcare system, even if everyone in our country had access to top-notch healthcare, we'd only prevent a small fraction of the annual deaths in the U.S. That's because behavioral factors account for 40% of these deaths.

Hang in there with me for this next paragraph.  At first it may seem all about me but just wait... I'm getting back to you.  I should tell you that I have a new job.  I've left the Rush-Copley Family Medicine Residency Program in Dr. Brenda's capable hands and taken a position as Illinois Medical Director for Your Healthcare Plus (YHP). YHP is a Medicaid program for improving chronic illness care throughout Illinois.  YHP was developed and is administered by McKesson Health Solutions

The reason such a program is needed is that we have had an EXPLOSION of chronic disease in recent years.  Why?  Well first let's consider which chronic diseases we're talking about.  Here are some that bubble up to the very top in frequency and severity.

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    Congestive Heart Failure (CHF)
    and other heart diseases
  2. Diabetes
  3. Asthma
  4. Hypertension (AKA high blood pressure)
  5. Chronic Obstructive Pulmonary Disease (COPD)--for example, emphysema--conditions due to tobacco smoke exposure

Some people call these the "Big 5". Turns out the healthcare expenses associated with the "Big 5" adhere quite well to the 80/20 rule. About 80% of healthcare costs are due to about 20% of the people in our country and the 20% are people with one or more of the common chronic diseases.


And see, the "Big 5" are very chummy with one another.  Diabetes really likes heart disease and hypertension and COPD is also known to call heart disease one of its kronies.

So what kinds of things do the nurses and health workers do within YHP to improve the health of the folks that carry the burden of these illnessesWell, they teach people about their conditions and their medicines, resolve barriers to getting to doctor appointments, treatments or medication supplies. But most importantly they work on BEHAVIOR.  For many chronic conditions, we behave our way into them so we must behave our way back out of them. So how might our healthcare system actually help to perform this most vital function of keeping us healthy?  There are vaays....


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Here comes the tickle monsta!

No... ever since we realized that tickling was a medieval form of torture the medical community has moved away from tickling as a behavior change strategy. 

What you really need is the all out version of the patient centered medical home. The patient centered medical home, discussed here by Dr. Brenda and here by Judith Graham, will incorporate a team approach so that your doctors office will be prepared to help you set health behavior change goals and support you in the management of your chronic condition with innovations like health coaches and group visits. 

The group visits will be with people who are working on the same types of lifestyle changes that you are so that you can learn from one another--a very effective source of help with behavior change. The healthcare team in your new patient centered medical home will also reach out to you so that support with achieving your goals is not just possible in the context of a doctor's "visit".  You can have e-visits with your healthcare team and virtual educational sessions. 

The world will be a better place all around, we'll all be slim and healthy, right?


Hey you!  Wake up!

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None of this is easy.  It won't be easy for us to change how we deliver care. There needs to be a business model for delivering such health-producing services in the medical home. And as I suspect you've already discovered, making a permanent lifestyle change is no walk in the park! You need to have the right combination of support, commitment, self-confidence, tools and strategies to get you there.  We all have a lot of hard work to do.  




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