Take responsibility for your own health

An excerpt from More Health Less Care: How to Take Charge of Your Medical Care and Write Your Own Personal Prescription for Lifelong Health.

Bob Baker is a patient of Dr. Lisa Martin. Bob works as an engineer for a Fortune 500 company that holds major commercial and Department of Defense contracts. He’s 45 years old and happily married with two college-age children. Bob’s lifestyle is stressful. He travels for business frequently, is expected to entertain clients, and always does “whatever it takes” to keep the clients and his boss happy. Unfortunately, keeping others happy has resulted in Bob’s diabetes, high blood pressure and his being 40 pounds above his ideal bodyweight of 170 pounds.

Bob was fit and trim when he married Susan, but his weight increased gradually over the last 15 years as he spent more time taking care of business and less time taking care of himself. The diabetes and the high blood pressure developed as a result of the weight gain. Susan has been concerned about his health for years and it’s been a contentious issue in their relationship, which has contributed to the stress in Bob’s life.

Bob’s been seeing Dr. Martin every three to four months over the last two years, and the appointments typically last 15 minutes. He has good health insurance, so he can afford the doctor visits, lab tests and medications. Dr. Martin has started Bob on a variety of medicines, but his blood pressure and blood sugar are not controlled to the optimal levels, and he has not been able to lose weight despite her urging.

 

“It’s hopeless”

Bob likes Dr. Martin but is getting frustrated with his chronic health problems and hearing bad news at every check-up. He also hates taking the prescribed medications, following a special diet and checking his blood sugars. In truth, he often misses his medication, eats the wrong things, and occasionally skips checking his blood sugars. Bob is thinking, It’s hopeless. I’ll never be any healthier than I am now. These medicines don’t work and with my schedule there’s just no way I can follow the diet or exercise plan that Dr. Martin wants me to. Doesn’t she realize that it’s impossible? No one could do it, especially me.

As his physician, Dr. Martin cares for Bob and wants to help him, but she likewise feels frustrated. Every time she sees Bob, Dr. Martin feels she’s failing him because she knows that his illnesses are not controlled to the standards that her professional association recommends. She would like to spend more time with Bob than a short 15 minutes but it “just isn’t possible” in today’s busy medical practice. Dr. Martin is also starting to believe that Bob is part of the problem. She thinks, Why won’t he simply follow the diet and exercise recommendations I’ve made over and over? I really can’t do anything more to help Bob if he won’t help himself.

 

The following summer, while Dr. Martin is on vacation, Bob sees her partner, Dr. Stone, for a routine visit. Dr. Stone discovers that Bob is on some older medicines and hasn’t had all of the recommended lab tests for his conditions. He makes a few changes for Bob and things get slightly better for a short while, but unfortunately they quickly revert to “normal.” When Dr. Martin gets back, she’s embarrassed about having overlooked the lab tests and not having considered a change to some of the newer medicines. She vows to try harder to keep up with the latest recommendations for the treatment of diabetes and high blood pressure.

The downhill slide

This pattern goes on year after year without any meaningful improvement in Bob’s health. In fact, the opposite occurs. Now age 55, Bob develops even more severe medical problems from his uncontrolled diabetes and high blood pressure. He is seeing Dr. Martin every other month, and has gained another 17 pounds. At 57 pounds overweight, he can’t even walk a city block due to his obesity, advancing heart disease and numbness in his feet. He’s on six medicines a day now, up from three when this story began, and all of his “numbers” are worse.

The next 10 years are not good ones for Bob. His life begins to be dominated by his medical problems. He sees Dr. Martin monthly for routine visits and urgent problems that happen all too frequently. Bob develops severe heart disease in addition to chronic kidney failure, major nerve damage in his arms and legs, and, of course, even more poorly controlled diabetes and high blood pressure. He is now experiencing chest pain once or twice per week. At the age of 62, he requires two coronary angioplasties followed by open-heart surgery. These help for a while, but after just three more years, he dies suddenly at age 65 of a massive heart attack.

Wait a minute, what happened here?

Everyone’s intentions were good. Bob wanted to get better, and Dr. Martin wanted to help him. Bob got a full dose of traditional healthcare; however he gradually got worse, felt terrible, and died too early! Yes, it’s true that the care he received slowed the progression of his illnesses compared with doing nothing, but it certainly can’t be called a success.

Over the course of the story, both Bob and Dr. Martin felt frustrated but both believed there was nothing more they could do to change things for the better. Gradually they accepted the situation as the best that could be done and Bob progressed through a long slow decline to an early death.

Perhaps you think this story is a little unrealistic, perhaps exaggerated for effect. I assure you it isn’t. It didn’t take too many years in practice for me to see this story, or one pretty similar, repeated over and over again. There are millions of Bobs and thousands of Dr. Martins all across America living out this unfortunate story every day. You may be Bob. Really! This is the day-to-day reality of many, if not most, primary care practices.

Bob’s slow decline and early death weren’t inevitable. There is a better way. I want to help you take responsibility for your own health, figure out what to do and how to do it, and then actually make the changes that can lead you to a healthier tomorrow. You can do it. You must do it. Your life literally depends on it.

Peter J. Weiss is an internal medicine physician and former health plan CEO.  He is author of More Health Less Care and can be reached at More Health, Less Care: Building America’s Wellness System.

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  • MassachusettsPCP

    How backwards. Telling the patient that he has shared responsibility. In my progressive state, the governor and legislature are looking to impose capitation on physicians, for the goal of not only reducing healthcare expenditures but also emphasizing overall positive health outcomes for the patient (or aggregate panel pool), with perhaps not just rewards but perhaps penalties and withholds for poor outcomes. The risk and effort is shifted to the healthcare ACO/doctor, as is the penultimate responsiblity … measureable outcomes. I don’t recall much new about patient responsibility in lifestyle choices or modifications. The standard “of course the patient and physician must collaborate to find a mutually agreeable and actionable plan”, something bland like that. I do recall that patient noncompliance is no longer considered politically correct; we call it “barriers to coming up with a mutual plan” and are told we as physicians are doing something wrong or not asking the right questions again and again … too expensive drugs? poor transportation? homemaker mom with limited funds and transportation? These will be solved in the future by the ACO/physician with no additional funds. I see no reason why we can’t have our sugary drinks, high calorie foods, cigarettes, alcohol, and still rework the language of the physician-patient relationship and the language of insurance contracts to emphasize more the providers’ responsibility, but let us not upset the patients’ lifestyle without their consent. If they do not consent or give excuses, tweak the framework of the problem from a patient problem or mutual patient/physician problem to a “provider/ACO problem” with deletrious outcomes.

    • http://www.drpeterjweiss.com Peter Weiss

      MassPCP,
      I agree with your points. Too much of what’s needed to help individuals be well is defined as “healthcare” and doctors are expected to do it. Helping America be well is not going to be about making the healthcare system do more. See my prior post here on KevinMD.com about health coaches.
      Pete

  • http://www.drpeterjweiss.com Peter Weiss

    David,

    I agree with your point. Who should determine the “guidelines” any way? Dean Ornish has been reversing diabetes and heart disease for decades but do you see the government issuing guidelines based on his work?

    In my book, my point is that we can create our own “guidelines.” We can figure out our own answers. It’s not rocket science and it’s not a mystery. Letting others tell us what to eat or what pills to take is a big part of our problem.

    My work is to empower individuals to be well. We can do it. Without more studies and without more pills. But people do need help. I aim to help them.

    Pete

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