In 2018, preventative medicine is at the forefront of the healthcare industry. The average individual in the United States lives to be 78 years-old, which can be attributed to a wider range of available medical information and increased technological advances. And even with a slight decline over the last three years –primarily due to drug epidemics in urban areas across the country – the U.S. life expectancy rate is anchored by the average non-drug using individual’s ability to receive the proper amount of treatment to eclipse the 80-year age mark.
But this doesn’t just fall on the doctor’s shoulders. It’s actually a two-part effort between the doctor and the patient. Both sides must meet in the middle.
As Dr. Mannan describes, “Most automobile owners will get their oil changed and their state inspections religiously, but put off their own physical exams without understanding their value.”
“I think the idea is, ‘Hey, I’m healthy, why do I need to go to the doctor?” he explained. “When in reality, so much preventable disease can develop during the 30-45 age gap that is completely symptomless, and that’s the problem. You feel good, but things in your body are changing”.
“During that 15-year period it is important to establish a relationship with a specific family doctor so when stuff does happen, you have someone you can trust who’s in your corner.”
Without an annual physical, two of the most common health issues that arise during the 30 to 45-year window are High Blood Pressure and Pre-diabetes. Both can be prevented or treated before serious complications arise.
“Those are definitely the two big ones,” Dr. Mannan said. “Consistently elevated blood pressures can cause damage to your kidneys, brain, heart, and eyes. Patients may not be obese, but they’ve gained some weight. They used to play sports or go to the gym, but now life keeps them busy. Slowly your blood sugar rises, and you're at risk for Pre-Diabetes.”
Catching these ailments early is the purpose of the annual physical.
Another issue is continuity of care
Instead of following up with their Family Physician people often treat their health issues on a singular case-by-case basis. If one injures their shoulder, they go see an Orthopedist. Foot problems? A Podiatrist. Seasonal allergies? An Allergist. And so on.
But in a lot of these cases, the patient’s symptoms can be effectively treated by a family physician, who can then point them in the direction of a trusted specialist if it is necessary. Longitudinal care is essential to receiving consistent and personalized treatment.
Q: In your opinion, how can you best identify which patients from 30-45 are likely to develop high blood pressure or diabetes?
A: The way I look at it as Nature vs. Nurture.
It first starts with genetics, nature. Your parents are a great roadmap to your health. If your parents have high blood pressure or diabetes then you’re more likely to have that as well. .. We have patients who are marathon runners, but they have high blood pressure because they were just dealt that hand.
How you play your hand is the nurture factor.
You can have patients with a great family history, but they play the hand they were dealt poorly. They have a poor diet, gain weight, and put themselves at risk for these diseases. When a patient in their late 20s or 30s comes in, one of the first things I ask them is about the health of their parents.
Q: In these cases, what do you feel is the most proactive treatment?
A: For me personally, I believe less is more when it comes to medicine. If someone comes in with borderline high blood pressure, I give them three to six months to cut out salt, increase aerobic activity and decrease stress. After that, if their blood pressure is still elevated then medication is necessary to prevent long term complications.
With pre-diabetes my initial step is a referral to a certified nutritionist and an exercise prescription. Then two or three months later, if things progress to Type 2 Diabetes then the recommendation of medication is necessary.
Preventing recurrent hospitalizations in the elderly.
As we grow older our reserve to fight off disease declines which can lead to recurrent hospitalizations. Dr. Mannan hears it all the time in his COPD patients,
“Dad has been in the hospital three times this year because of his breathing”.
Yes, the ER is the safest environment to ensure the patient’s medical condition doesn’t take a turn for the worst. Although more often than not, these conditions can be prevented by frequent visits to a family physician rather than multiple visits to the hospital. For example, instead of winding up in and out of the ER, a patient could see their physician four to six times over a year – each appointment lasting 30 minutes at most – to address health concerns that have the potential to develop into serious conditions.
“At these appointments, I’ll ask them diagnosis-specific questions,” said Dr. Mannan. For example with a patient who has COPD; “How’s their breathing? Do they need refills on medications? What’s your quality of life? Has anything changed? Are there any sick people around you?
Brief frequent visits can often be the solution to prevent lengthy recurrent hospitalizations.
Q: Sometimes older patients can be a little stubborn about their health. What do you feel is the best way to combat that?
A: By taking a team approach to their health that involves the immediate family members. In these instances, it can really be an interesting conversation. At this point, these patients are stoic. They’ve been through life and don’t want to make a big deal out of what they feel are small medical issues. But it’s really important to have their family members in the room to be able to voice their opinions and sometimes provide a reality check.
In part two of the series, we’ll explore the differences between palliative care and hospice care, the proper way to manage drug regimens and the importance of establishing healthy behaviors. For more health-related information, stay up to date with the Genesis Medical Associates blog.