This article combines excerpts from a blog posted by a physical therapist working for a home health care agency based in the US Northwest with Symmetry’s commentary about how we believe that his thoughts are relevant to practices like ours that provide care on an outpatient basis. The original blog by Ben Shatto, PT, DPT, OCS, CSCS first appeared at Smart Strategies for Successful Living – a community based website at AgeGracefullyAmerica.com.
Ben writes:
“Being proactive about your health has never been more important. The health care system in the United States is set up brilliantly to prevent you from dying and for maximizing profits of all parties involved. In fact, the United States spends more money by a wide margin than any other country on health care. Our health care system is set up to keep us from dying, not thriving. Our average life span barely makes it in the top 30 when compared to other nations.
As it stands now, the American health care system is poorly equipped to help us maximize our health span. Health span is defined as a period of time in which a person is generally healthy and free from serious disease. It’s up to you to manage your health and maximize your health span.
As health care costs in America continue to increase without actual positive change in our health status as consumers, our overall health delivery system continues to be strained. Medical professionals are being over burdened by daunting rules and regulations that limit patient care. There are rules that prevent creative personalized solutions because of “standard of practice” rules.”
Ben’s comments are relevant to all age groups. Historically, the United States has focused on “sick care” or “injury care” rather than “well care” or “preventative health care”. We’ve advanced our medical technology and our clinical practice across the board and as such have become extremely specialized in things like “robotic assisted knee replacement surgery” and “ultrasound guided injections.” It is not uncommon for an individual person to make regular visits to a health care team that includes a heart specialist, a neurology specialist, a knee or shoulder specialist, a foot specialist, and so on – with each specialty clinician evaluating and treating each of the various organs or body systems with an amazing array of “cutting edge” or “pioneering” interventions. In some ways, this system is providing advanced care that would not have been possible a couple of decades ago. However, in other ways, this system is continuing to create huge healthcare expenses while also failing to deliver a superior health care “product.”
As Ben notes, the US life span is comparing poorly with that of many other nations. Our national rates of heart disease, diabetes, hypertension, and mental illness are awful. According to the National Health Council’s most recent statistics (based on data from 2018), 40% of the US population is living with at least one “chronic health condition”, and approximately 30% of the population deals with multiple chronic conditions. This situation translates to TRILLIONS of dollars spent annually on treatment costs and/or lost economic output related to disease.
We’re missing the forest for the trees. We’re providing tons of crazy advanced procedures, but failing to recognize the value of low risk, relatively low cost, “front-end” interventions that would improve health and quality of life while also enabling the health care system to function more efficiently and effectively. In Symmetry’s opinion, often absent from an individual’s health care team are medical GENERALISTS – practitioners who look at “the forest” rather than at one individual tree. These folks assess health in general terms and work to keep all body systems functioning in balance. These folks can recognize when an issue with one system is negatively impacting another and can recommend corrective intervention before anything gets too far off track. Remember hearing of the days of the “family physician” – a single health care provider that assisted with a baby’s birth and then continued treating that baby through childhood and into adulthood and old age? This practitioner knew his or her patients well and as such could readily recognize when an aspect of health was “off”. In many cases, this practitioner could intervene early when an issue would arise and work with the patient to restore health before function declined substantially. Or, the practitioner could help the patient to acquire additional care when it was determined that it was needed. In today’s health care system – often a patient will seek out a specialty provider as their initial point of entry into the medical world. And then these specialty providers will look in great detail at whatever it is that they look at. Because these practitioners are used to looking at primarily one specific thing, it is likely that other contributing conditions or factors are not considered when developing a treatment plan. This is the fault of a “glitch” in the system, which should be designed to send patients to specialists only after it has already been determined that a patient actually requires specialty care. Here is an example:
A past patient at Symmetry began noticing that she would wake up with a “pulling pain” in one leg, as well as with odd hot or cold temperature sensations in the leg that were not present in the other side. Thinking that unusual hot/cold sensations might indicate that “something going on with the nerves”, the patient scheduled an appointment with a neurologist. The neurologist sent the patient for an MRI examination of her spine to look for any potential structural issues that might be impacting the nerves. The patient was also sent for electrical testing of the nerve signals and muscle responses in her leg. The cost of this specialty physician office visit and the 2 advanced imaging examinations likely totaled $1500-$2000. While her imaging results were pending, this patient had scheduled an evaluation at Symmetry. During the evaluation, she told her therapist that she had been sleeping in a sitting position in a recliner for several months while recovering from a shoulder surgery. Recently, she had tried to go back to sleeping flat on her back in her bed, but found that she could not sleep more than a short time in this position because it would provoke the “pulling pain” and odd temperature sensations in her leg. If she got up with went back to her recliner, the symptoms would ease. This patient was found on physical examination to have a stooped posture and both muscle and nerve tissue tension. She was taught several stretching and posture exercises that were comfortable for her to perform. The cost of this visit was approximately $200. A week or so later, this patient was much more comfortable sleeping on her back in bed. She was also relieved to find that her imaging results were “unremarkable” – meaning that her nerves and spine looked normal. Ultimately, the patient attended 2 more physical therapy visits and then opted to continue to work on home-based mobility exercise, as she was no longer having any symptoms.
For this patient, the medical system worked “backwards”. She initially skipped a general health overview and a minimal non-invasive change in activity, which was ultimately sufficient to correct her minor alteration in health status. Had this patient entered the health care system via a general practice avenue (in this case, via a physical therapist), this care would have been provided before assessing whether or not there was any need or indication for further specialty practitioner involvement. This would have been more efficient for both the patient and the neurologist. The patient could have eliminated several additional stops along the route of the medical pathway. And the neurologist could have utilized the time and resources provided to this patient for a different patient that for whatever reason been determined to need further specialty assessment after their general practice examination.
The point of this story is to suggest that one major way that each of us could manage our own health is by seeking out medical practitioners who approach health care from a generalist’s perspective. And then we could utilize these practitioners as initial entry points into the health care system.
Ben’s blog also goes on to suggest the following:
Top Reasons Why You Should Manage Your Health:
“Money – Health care is expensive. Many of the most common treatments and fancy diagnostic methods are not necessary. Costs are only going to rise more in the future. As this occurs, it will be even more important to be able to take care of the simple common place injuries and illnesses. It will save you a lot of time and money! Benjamin Franklin was right: “An ounce of prevention is worth a pound of cure.”
As in the example described above, it makes sense from both health and fiscal perspectives to seek out relatively low-cost, low-risk treatments before proceeding along a path of higher-cost procedures that also often involve an increased degree of risk. Front-line medical providers should spend a lot of time utilizing their clinical examination and reasoning / thinking expertise to design sensible treatment plans that start simple and get more complicated only when needed.
“Empowerment – There is nothing more important than your health. You have control of most of the aspects in your life that affect your health status. Taking care of yourself and your health needs leads to a sense of empowerment. Understanding your body and your health is liberating and empowering. Our ability to understand our own unique body has never been more possible.”
As a health care consumer, you can choose how you utilize the health care system. If you don’t already have a GENERALIST or two on board to assist you with your health status, it might be prudent to establish some new relationships. Physical therapists are one example of generalist providers that address multiple systems in the human body. If you have health status issues that impact your ability to move comfortably and/or accomplish typical daily work or self-care or recreational activities in the world, a physical therapist can help. PTs work with the musculoskeletal system, but also with the nervous system and the cardiac and pulmonary systems and the balance and vestibular systems. Other general practice medical providers are physicians and/or nurse practitioners that work in Family Practice or Internal Medicine clinics. These folks comprehensively treat multiple body systems and types of disease and dysfunction for patients of all ages.
“Improved Care – If you understand how to be healthy and take care of yourself, you will be able to assist your medical practitioner in making the best decision on how to manage your care. Remember, it is your body and your health. By being your own advocate, you can insure that you receive quality care. Knowing yourself is the best way to insure the healthcare you receive is appropriate for you as a unique individual.”
Regardless of how much training any medical practitioner has completed, they cannot possibly know every aspect of YOUR individual situation or health experience. Optimal health care involves ongoing communication and collaboration between a patient and a provider. A long-term relationship – as used to more frequently occur with a physician that would treat each patient from their birth day to their dying day – is a valuable asset for health and wellness.
“Quicker Recovery Time – Often by taking out the middle man, you can help to increase the speed of recovery. You can address the condition and help your body to initiate the healing response to insure a faster recovery.”
It is widely accepted that early intervention in a multitude of health situations – both related to injury and illness or disease – yields the most efficient and effective outcomes. It is a good idea to ask your health care provider about how early treatment might positively affect your individual situation and then to work together to plan your treatment strategy accordingly.
“Healthy Living – Take the time to focus on your health. Often, small changes in your diet, activity level, and relationships can make a big difference. You can take control of your health and your life! Don’t underestimate what leading a healthy lifestyle can really do for you as you look to improve your overall health span.”
It is standard practice to intermittently manage many things in daily life. We change the oil in the car periodically. We cut our hair and nails. We mow our lawns. We visit the dentist and our men’s or women’s health practitioners for “well checks”. General physical health should be no different. Visiting your generalist practitioners at least a couple of times each year is a good idea, so that developing issues can be recognized early and addressed simply – before significant impacts on health and function occur.
Ben’s blog concludes as follows:
“Western medicine is designed to keep you alive, not to help you thrive. Taking a passive role in your health is not a wise choice in America’s current health care environment. Only YOU are responsible for your health. Decisions now will determine how successfully you age in the future.
There is nothing more important than your health. You must be in control and manage your own situation. You have control over most of the aspects in your life that affect your health and well-being. Take charge, and empower yourself. You must be your greatest advocate. Don’t delegate the most important job of taking care of yourself and your health and well-being!”
Do, however, create relationships and cultivate partnerships with your health care providers. Your well-being is worth the investment!