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Imagine this: you get the call in the middle of the night that your mother is in the hospital with excruciating pain. You rush to the emergency room to comfort her and find the doctor at her bedside asking critical questions. She's in so much pain that all she can say is "I don't know." She may need emergent surgery so the doctor turns to you for more information -- does she take blood thinners? does she have any important allergies? what medications is she currently taking? -- all questions that determine if its safe for her to undergo surgery but unfortunately you can't answer those questions either. What do you do?
The time to be informed, educated and empowered with your full health history readily available and easily accessible is now. The COVID-19 pandemic has revealed health disparities at a rate more alarming than pre-pandemic. What's worse is that research shows that 3 of the top 10 reasons for poor health outcomes relate to: 1) misdiagnosis, 2) delayed diagnosis and 3) medication errors.
In this episode we unpack a REAL LIFE scenario from my clinical practice, tips that put you in the offense not the defense and strategies for being a better patient than you've ever been before.
People often ask if lifestyle medicine is different from conventional medicine and regular doctor visits and the answer to that is no, not at all. Almost all clinical practice guidelines for the top chronic disease support Lifestyle Medicine as the first line of treatment and the American College of Lifestyle Medicine suggests that as clinicians we start putting as much focus on Lifestyle Medicine as we do medications and procedures.
For example, let’s take a look at the American Heart Association and American Cardiology clinical guidelines for hypertension: table 8 is full of lifestyle modifications: salt reduction, healthy diet, healthy drinks, moderate alcohol consumption, weight reduction, smoking cessation, regular physical activity, reduce stress and induce mindfulness, reduce exposure to air pollution and cold temperature. And though it isn’t listed here, what I would add would be adequate sleep since there are hundreds if not thousands of studies on the role of sleep in heart health, the implications of sleep apnea on heart health and so on. And I know that my colleagues in sleep medicine and pulmonary medicine would support that.
So all together here are 9 different interventions that are clinically recommended for managing hypertension or high blood pressure.
Let’s look at the clinical guidelines on elevated blood sugar. For that, we turn to the American Association of Clinical Endocrinology since diabetes is an endocrine disorder.
“Early intervention to prevent progression to T2D in people with prediabetes and/or abnormal adiposity with insulin resistance is important because later intervention to manage T2D and its complications is generally more expensive and carries greater risks.”
“Lifestyle optimization is essential for all patients with diabetes. Lifestyle optimization is multifaceted, ongoing, and should engage the entire diabetes team. However, such efforts should not delay needed pharmacotherapy in higher risk individuals, which can be initiated and continued simultaneously and adjusted based on patient response to lifestyle efforts. The need for concurrent medical therapy should not be interpreted as a failure of lifestyle management but as an adjunctive intervention.”
“Minimizing risk of weight gain and abnormal adiposity and promoting weight loss in those patients with adiposity-based chronic disease (ABCD; the medical diagnostic term for overweight/obesity), are high priorities for long-term health. Given its ability to prevent progression to diabetes and promote a favorable therapeutic profile in diabetes, weight loss should be strongly considered in all patients with prediabetes and T2D who also have ABCD. Weight-loss therapy should consist of a specific lifestyle prescription that includes a reduced-calorie healthy meal plan, physical activity, and behavioral interventions.”
“Lifestyle therapy begins with motivational interviewing techniques, nutrition counseling, and education. All patients should strive to attain and maintain an optimal weight through a primarily plant-based meal plan high in polyunsaturated and monounsaturated fatty acids, with limited intake of saturated fatty acids and avoidance of trans fats.”
“The clinician, a registered dietitian, or a nutritionist (i.e., a healthcare professional with formal training in the nutritional needs of people with diabetes) should discuss recommendations in plain language at the initial visit and, at least briefly, with each follow-up office visit. Discussion should focus on foods that promote health, including information on specific foods, meal planning, grocery shopping, and dining-out strategies. Patients should be instructed on proper interpretation of Nutrition Facts Labels on packaged foods. Clinicians should be sensitive to patients’ ethnic and cultural backgrounds and their associated food preferences.”
So what is this, my friends? All of this is lifestyle medicine. And this is the missing link in Mary’s scenario.
So here’s what I want you to do. I want you to craft a picture in your mind of what it means to be a good patient and here’s the definition that we use in my Fit & Functional For Life health coaching program: a good patient is a patient who is empowered to be an advocate for themselves. Full stop. Does a good patient know everything? Absolutely not. Being an advocate does not mean knowing everything, it simply means operating from your own best interests, identifying your blind spots, seeking out reliable information that you need, information that you can apply and then applying it and refining your process over and over again.
Here are some tools for becoming a good patient:
Sources for patient education for the most common chronic health conditions:
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