Inspired Medicine: Getting Patients to Make Healthy Changes

Bert R. Mandelbaum, MD, DHL (Hon)


January 31, 2018

Troubling Trends

Life spans in the United States are getting shorter and death rates are up. To me, this means that we aren't doing our jobs as physicians. More important than healing our patients' flesh, we must inspire them to become the agents of their own salvation.

For the first time since 1993, when the HIV epidemic was at its height, life expectancy dropped from one year to the next, according to the Centers for Disease Control and Prevention.[1] The decline wasn't huge. Life expectancy at birth fell from 78.9 years in 2014 to 78.8 years in 2015. The death rate increased from 724.6 deaths per 100,000 people in 2014 to 733.1. But if that trend continues in coming years, it will add up to a frightening reversal in decades of improving health in this country.

Unlike 1993, when AIDS was the clear culprit, the causes are now varied. The leading causes of death remained the same in 2014 and 2015: heart disease, cancer, chronic lower respiratory diseases, unintentional injuries, stroke, Alzheimer disease, diabetes, influenza and pneumonia, kidney disease, and suicide. Of these, the rates of death decreased only for cancer and held steady only for influenza and pneumonia, while increasing for all of the others.

Healthcare's Misdirected Resources

As physicians, we can significantly reduce the effects of all of these diseases, possibly even including Alzheimer disease. But we can't do that in the way that our healthcare system directs us to take action.

The business of medicine puts its emphasis on the treatment of people who are already very sick. As an orthopedic surgeon, I got training mostly in how to repair damaged bones, joints, and flesh, and that's what I'm paid to do. But by the time someone has torn a ligament, suffered a heart attack, or lost a kidney, their lives will most likely be shorter no matter how sophisticated the drugs or surgery we have to offer.

I believe that performance and prevention are just as important as treatment, and as Galen wrote in 150 AD, philosophy is as important as science and technology.

That's why I devoted myself to helping the Fédération Internationale de Football Association (FIFA) create a training program that dramatically reduces the risk for lower extremity and ACL injury in athletes. It's why I've spoken out about the importance of screening for sudden cardiac death and making automatic external defibrillators available at sports events.

But I believe that physicians can have their biggest impact by inspiring patients to take charge of their own health.

Emphasizing Traditional Interventions

With that in mind, I wrote the book The Win Within to share my personal philosophy on motivation and success. Currently, I'm working with the University of California, Los Angeles to get this message to medical students there.

One of the points I make in the book and in my talks is that you are what you eat, drink, think, and do. Consider that list of the 10 leading causes of death. The effects of smoking, exercise, and diet on diabetes, heart disease, cancer, and stroke are well known.

Kidney disease results largely from diabetes and high blood pressure[2] and is influenced by these same lifestyle factors.

Vaccines can significantly reduce the risks from influenza and pneumonia. Strength and balance training can prevent unintentional injury. Hand washing and avoiding smoke and other air pollution can prevent respiratory diseases.[3]

Even the risk for Alzheimer disease can be reduced through exercise.[4]

We can't force our patients to stop smoking, exercise, eat well, get plenty of sleep, or receive vaccines. We can't grab the guns out of their hands if they've made up their minds to shoot themselves. But we can inspire them to take care of themselves.

Let's start with the opioid addiction problem. We need to adopt better prescription practices. More than that, we can help our patients understand that they have other options for controlling their pain, such as less-addictive medications, physical therapy, cognitive behavioral therapy, and mindful meditation.

If I'm talking to patients who have torn ligaments, I tell them that adversity is the engine of unimagined opportunities. I tell them that our mission is to turn that injury into an experience that will improve their whole lives.

I often meet people who weigh 250 pounds. They come to me because they've got osteoarthritis and meniscal tears in their knees, but we both know that's only the tip of the iceberg. Nothing I can do to these patients' bodies will truly help unless I can also heal their spirits.

Opportunities to Inspire

I don't mean that I preach religion. I mean that I offer them a perspective. I tell them that they have the DNA of athletes, that their ancestors survived by outrunning their prey. I tell them that their bodies are just waiting for them to take action. I suggest that they take a brisk walk and notice how their bodies wake up. Pretty soon, their endorphins and neurotransmitters kick in. More than one of these patients has come back to me 100 pounds lighter and eternally grateful.

Over and over, I encourage my patients to look for discovery and adventure, to seek rich experiences rather than experiences that make them rich. I tell them to think positively in everything they do.

As physicians, we can spread these messages not only to our patients but everywhere we go, by facing our own challenges with optimism, by developing our strength of character, and by cultivating relationships.

As individual physicians, we can't change Brexit, taxes, or healthcare policy. But we can speak to the local PTA, strike up a conversation in the elevator, and make a friend of the person who vacuums the office floors.

There's a reason why the lifespans in places like Monaco and Japan are so much longer than ours, and it's not superior DNA. It has a lot to do with culture, and as physicians, we must lead the change.


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