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“Lifestyle medicine’s foundational pillars include a specialized look into diet, physical activity, sleep, stress, mood, substance use, and relationships. Creating a patient-centered plan of care based on these areas are proven successful in preventing, treating, and reversing chronic diseases.
Some may say that health care providers do not have time to focus on intensive lifestyle modification in their visits with patients. This is true in the current fee-for-service, physician-dominated care delivery model.
But to be successful in obtaining shared-cost savings in the value-based care and as accountable care organizations, it is urgent to shift to utilizing more nurse practitioners, dietitians, nurses, social workers, and health coaches in chronic disease treatment and prevention.
This makes it possible to reduce the social and economic impact that many chronic illnesses place on individuals, the health care system, and society.
There is indeed a better way to better health for all Americans.”
Elizabeth Simkus is a nurse practitioner.
She shares her story and discusses her KevinMD article, “It’s a lifestyle: Adopting a behavioral approach to health care is urgent.”
Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Elizabeth Simkus. She is a nurse practitioner, and she wrote the KevinMD article “It’s a lifestyle: Adopting a behavioral approach to health care is urgent.” Elizabeth, welcome to the show.
Elizabeth Simkus: Kevin, thanks for having me. I’m so excited to be here.
Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?
Elizabeth Simkus: Sure. Yeah, so I always knew I wanted to do something in health care, and during high school and in undergrad, I worked as a pharmacy clerk and technician. At first, I thought that was the route I was going to take, but I decided against that. So I finished my biology degree and then moved here to Chicago, worked a couple of sales jobs, and then really took the time to figure out what area I wanted to go into in health care. That’s when I found Rush University and their generalist entry-level master’s program, and I’ve been at Rush ever since.
So I did the master’s program in nursing, and during that time, one of my professors, Dr. Sally Lemke, introduced me to Rush’s school-based health centers that they have on the West Side of Chicago. I did an internship there during my nursing program, where we implemented, from a grant, a lifestyle modification program for the adolescents. We did one-on-one and group visits, and even a community- and school-based intervention that looked at diet, physical activity, sleep, and screen time. That was really my first introduction to more of the lifestyle side of health care, and I absolutely loved it.
So then, fast-forward to graduation, I worked on an adult med-surg unit, nights, with patients who had chronic diseases. Maybe they were in for a CHF exacerbation or diabetes. We were an oncology overflow unit, where patients with cancer who maybe had pneumonia had come to get treated. So it was intense. It was a lot of work, and it made me realize I really wanted to pursue a more lifestyle approach in the health care field.
So I went on to get my doctorate of nursing practice as a family nurse practitioner at Rush. During that time, my clinical rotations were mainly with primary care providers, physicians and nurse practitioners. But during the program, I learned of Rush’s preventive medicine department, which has the clinic, the Prevention Center. So I had reached out to their chair, asking if I could do a clinical rotation with them. So I did, with their nurse practitioner, and kept in touch with her after graduation.
I worked with our bariatric surgeons, seeing patients long term after their surgery, and helped them stay on their lifestyle modification goals and weight-loss journey. So that was a great experience. And then when a position in the Prevention Center opened up, I jumped on it, and I’ve been here. That’s when I was formally introduced to the American College of Lifestyle Medicine, and that’s what brought me to where I’m at today.
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Kevin Pho: So before we get into the article, let’s have a little bit of context. What is the formal definition of lifestyle medicine?
Elizabeth Simkus: Yeah. So the American College of Lifestyle Medicine, or, yeah, lifestyle medicine, was founded in 2017, and it’s based on six pillars of health. They look at evidence-based interventions surrounding diet, physical activity, sleep, and stress. We look at mood, substance use, and social connections, because we know that all of those different areas within our life can impact how our body functions and how we can help prevent, reverse, or treat chronic illness.
Kevin Pho: All right, and you talk more about that in your KevinMD article titled “It’s a lifestyle: Adopting a behavioral approach to health care is urgent.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?
Elizabeth Simkus: Sure. Yeah, in terms of why I decided to write it, I have felt fortunate to have the opportunity at Rush to be within their fifth annual cohort of their OpEd Project. With the OpEd Project, it’s a cohort of about 40 people, and we work with editors and writers to get our voice out there, similar to what you do here at KevinMD and on the podcast. So they help us and kind of train us on how to do that, which is fun. I never envisioned myself as a writer before, but it’s been a great experience.
So then, as I decided on what topics to write on, my involvement in lifestyle medicine over the last couple of years was like an aha moment for me. And so I really just wanted to share that experience and to show people that there is a way, and an urgent need, for lifestyle medicine. Six out of every 10 Americans have a chronic illness, and four out of every 10 have two or more chronic illnesses. As you know, this makes up a majority of our national health care spending and the number one cause of disease and disability in America. So what we’re doing just isn’t working.
And so there is a place for lifestyle medicine, and we’re practicing it here at Rush. We’ve got myself as a nurse practitioner, we have an internal medicine doctor who’s also certified in lifestyle medicine, a cardiologist doing preventive cardiology, and also psychologists. So we work as a team and meet people where they are in their health journey, and help them make small changes in all those pillars of health in order to prevent progression of chronic disease, or even treat and sometimes reverse it. So it’s super exciting, and I’m just passionate about it. I love it.
Kevin Pho: Walk us through a typical day of yours. Tell us, what are some common patients that you see, some common conditions that you address, and common ways that you solve these conditions?
Elizabeth Simkus: Since the pandemic, too, we’ve been able to implement telemedicine, so I see patients either in person or virtually. For a new patient, usually we get referrals from primary care, sleep medicine, cardiology, from various different specialties, or some patients refer themselves directly. And so I will see patients that have either just recently been diagnosed with, say, prediabetes, diabetes, high blood pressure, or sleep apnea, or they have elevated liver enzymes. Or, on the other side, patients who come in are somebody who’s had these chronic illnesses for a decade or more.
The most fantastic part of the clinic is that we have the time. We have the time to really dive into these patients’ lives and make a plan that’s appropriate for them and that’s going to work for them. So I get an hour with new patients and a half an hour with returns. We have a long inventory intake form that covers all those pillars of health, diving into their weight history, their dietary patterns, their work, their social life, their family, and on and on, to get a sense of where there may be opportunities for making small tweaks or changes.
And then we work with the patient to say, “OK, here’s where you’re at right now in your life. Which area do you want to focus on first? What do you think, with some guidance of, you know, these are some options, what do you think is going to work for you?” Now we make goals, and then we follow up with them frequently, every two to four weeks, to assess for any successes and barriers, monitor progress, and then we check lab values and whatnot. So it’s been really fun.
In addition, one other thing I wanted to mention is we also started a closed Facebook group for our patients. We do interviews on there, we do Q&As, post recipes, just encouragement, kind of this healthy community that we want to create for our patients in between our visits, because we know that health is developed out there, not within the four walls of our visits.
Kevin Pho: One of the things that you mentioned earlier was that you guys meet patients where they are. So what exactly do you mean by that, and can you give an example, perhaps, of how your team can meet patients where they are?
Elizabeth Simkus: Definitely. One patient that I’m thinking of, he was a single bachelor, just retired, and he ate out most of the time and didn’t really cook at home. He had uncontrolled diabetes on multiple medications. We worked slowly at, OK, trying to do oatmeal instead of eating out and having pancakes multiple times per week. We started with walking. He bought a Fitbit, or a pedometer, to be able to track his steps. And so we slowly kind of built and progressed on where they were in terms of their diet, physical activity, and their social connections, and then make small changes in order to get them on the path that can be empowering and motivating for them once they see the results.
Kevin Pho: We’re talking to Elizabeth Simkus. She is a nurse practitioner, and she wrote the KevinMD article “It’s a lifestyle: Adopting a behavioral approach to health care is urgent.” Elizabeth, not every primary care clinician has the luxury of time. So we certainly don’t spend half an hour to one hour on new patients. We often get 15 to 20 minutes in the exam room. So I agree with you that changes in patients’ lifestyle are tremendously important, but what are some high-yield tips that you could share with my clinician audience to maximize any type of advice that they can give in the exam room during that short period of time?
Elizabeth Simkus: Yeah, that’s a great question, because I totally agree with the time constraints in our traditional fee-for-service landscape of health care. One thing that I could say is, if a patient is recently diagnosed with a chronic illness, sitting down with them and finding out their why: Why is it important for them to address this and prevent progression? A lot of my patients, that really hits home with them. I’ve learned it from other lifestyle medicine providers, but it helps them to realize, “OK, yes, I saw my grandmother or my aunt or some other people go down the road of diabetes and their uncontrolled state, and I don’t want to go that way,” or, “I want to be there for my patients.”
So when patients really connect with their why, of why they want to address it, that can help motivate them and also get back on track for when lifestyle change is hard. We’re not going to be perfect as we move forward, but if they remember the why, and we understand that as a provider and remind them of that, that can help them be more successful in their lifestyle changes and behavior modification.
Kevin Pho: And if clinicians are interested in researching more about lifestyle medicine, what kind of resources do you recommend?
Elizabeth Simkus: Yes, I would definitely first start with going to the American College of Lifestyle Medicine website. There are a ton of resources, and they list a whole section on the evidence base and journals and research that’s on the practice of lifestyle medicine. And then I follow a lot of the pioneers. There’s Dr. Michael Greger; he has NutritionFacts.org. There’s Dr. Dean Ornish, and many others. Once you start getting into it, I really feel like, for me, I found my people, and I love everything about connecting with other providers who practice lifestyle medicine. It’s a great specialty to be in.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Elizabeth Simkus: I would say definitely there’s a place for lifestyle medicine in our health care schematic, right? And of course, there is a need for medications, and there’s a need for interventions and traditional treatment. But lifestyle medicine has a very powerful impact and can make a great impact on our patients’ health and our economic landscape of health care spending. It has a big impact that can make a difference in the health of our nation.
Kevin Pho: Elizabeth, thank you so much for sharing your time and insight, and thanks again for being on the show.
Elizabeth Simkus: OK, thanks, Kevin.
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