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How To Have A Healthy Old Age: Food For Thought On Labor Day

I’ve spent the last couple of weeks making house calls to “at risk” seniors in rural South Carolina. At the rate of about 7 house calls per day, I was able to make some observations based on a respectable sample size. I was both surprised and intrigued by the living conditions I encountered, and I’m pleased to report that I have now performed my first physical exam under the careful scrutiny of a cat, rooster, and hen team (photo at left). On another house call I was offered a pygmy goat as a thank-you for my efforts, and countless good-natured folk offered me home made iced-tea and such edible delectables as fish patties and peach honey.

But what struck me the most was that certain seniors were in far better health than others their age, and that the healthier ones all had one thing in common: strict daily exercise regimens. I realize that this is not ground-breaking news (that exercise is good for us), but the stark contrast between those who exercised and those who didn’t could not have been clearer to me.

One particularly charming 85 year old man gave me a tour of his vegetable garden, and explained that he bicycled into town six days a week to give away okra (and other veggies) to church friends and town folk. Growing vegetables and giving them away was his current life’s work, and although he lived in extremely modest circumstances, what he owned was tidy and clean. He was joyful, bright, and had the physique of an athlete.

Contrast this man to another patient in his 80′s who didn’t exercise at all, and stayed inside smoking cigarettes most of the day. He was blind in one eye, nearly deaf, struggled to breathe, had sores on his skin. He was depressed, over-weight, and swollen from heart failure. I was so sad to see his condition, and the relative squalor in which he lived. Urine and smoke odor permeated the house, and I wondered how much longer he would survive.

When I arrived at another octogenarian’s home, I noted that the garage was filled with watermelons of various sizes. Upon further inquiry, the gentleman said that he had hand-picked the watermelons from a plot of land that he owns 2 miles from his house.  He brought them back to the house with a wheel barrow… and had made many trips back and forth over the past week. He was taking no medications and had a completely normal physical exam.

And so my days went – back-to-back visits with seniors who either were engaged in an active lifestyle, or who were wasting away, cooped up indoors with advancing dementia and chronic disease. I realized that no medical treatment has the power to overcome the relentless damage that inactivity, smoking, and deconditioning cause. The secret to a healthy old age lies in lifestyle choices, not pill bottles.

As we enjoy the last holiday weekend of the summer, let’s consider how important labor actually is to our mental and physical well being. You’re never too old to haul watermelons down the road, grow okra for your neighbors, or simply commit to smoking cessation and daily walks. If you do this regularly, your health will surely improve – and your quality of life will be enhanced immeasurably. In the end, adding life to years is what medicine is all about.

Does The Next Generation of Physicians Know What They’re Getting Into?

Doctors have an image problem.  People see us one way.  Perhaps more importantly, we see ourselves one way.  And it seems to start at a young age.

I had a premedical student in my office recently – A friend of a friend interested in a career as a doctor.  And as I often do I like to ask the question, ‘what do you think medicine will be like when you’re done training?’ It’s something of an exercise.  I usually get an answer involving some combination of hospital rounds, physical examinations, telephone calls, and busy office visits.  Occasionally I’ll get rehearsed nonsense about black leather bags and house calls.  The young woman in my office didn’t fail to deliver.

What does the next generation of physician know? Read more »

*This blog post was originally published at 33 Charts*

Medicine Vs. Religion: My Brother’s Keeper Revisited

A few weeks back, I had introduced a patient who was willing to let her religious beliefs stand in the way of receiving the proper medical treatment she needed to stay alive. I want to revisit with you this dying patient, who hadn’t known me or any doctor for over 30 years.

As the rest of the family, who were not as committed to a religious path, stood by her expectantly, I said to her: “I had a brother who was a true believer in the power of God and that faith could heal all things or be called God’s will. Like you, he was a competent adult in charge of his decisions. He wouldn’t listen to anyone else — not his wife, father, mother, children, brother — not even me, the doctor. He died two years ago, leaving behind 10 children and a wife who depended on him. We all believe he died unnecessarily.

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PECOS: A Back Door Way To Force All Physicians To Accept Medicare?

This upcoming January 4, 2010 will prove an important date for any physician who prescribes durable medical equipment for their patients to use in the home.  The Centers for Medicare and Medicaid Services (CMS) have implemented an internet-based enrollment process for Medicare termed PECOS, another progeny of the 1996 HIPAA legislation.  PECOS stands for Provider Enrollment, Chain and Ownership System and was created in large part to prevent fraud.  Yet when I called the PECOS helpline, fraud was not a concern, and it was explained to me that PECOS is an internet version of my Medicare Application.

Since my practice makes house calls, we treat a variety of home-bound patients unable to make it to a doctor’s office without great effort.  We care for stroke patients, quadriplegics, those with end-stage pulmonary disease, and many simply weakened by the effects of advanced age.  Most need equipment like mattresses to prevent recurrent pressure sores, wheelchairs, nebulizer machines, or oxygen.  A patient depends on their physician’s ability to order anything necessary, and it is imperative this be done without creating an exorbitant financial burden or by denying them a Medicare benefit already paid for. But, according to our Home Supplier, if we haven’t enrolled by January 4 then our Medicare & Medicaid patients will have to pay 100% of the cost for any equipment prescribed. Read more »

Sent Elsewhere: Pharmacy Conglomerates Hoarding Flu Vaccines

I’m working with a small team of primary care physicians in Vienna, Virginia. Part of their strategic business plan is to offer flu shots to local residents via office visits and house calls. Just last week I accompanied Dr. Alan Dappen on a series of flu shot house calls to the frail elderly. They were too weak to come to the office, but wanted to be protected from life-threatening flu. I was really proud to be able to care for them in their own homes and wondered how many emergency room visits we would avert this season with our strategy.

The answer may be “fewer than I thought” – but not for the reason I expected. As it turns out, a local pharmacy conglomerate has bought up most of the flu vaccine supply, so that our practice can’t get any more. Although we have hundreds of patients requesting flu shots, we just don’t have the goods. And I can tell you that the frail elderly (who would have benefited from our house calls) won’t go to the pharmacy to get them. They’ll be at risk for the flu, and will have to wait until we can get more vaccine – whenever that happens. Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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