For These Doctors and Patients, Health Means "Personal Best"
Grandinetti, Deborah, Medical Economics
A growing breed of wellness-oriented physicians feel that relieving symptoms is no longer enough.
Vermont dentist Wes Riverton is happy with the care he receives from his regular physicians. But for more than a year, he's made routine-sometimes weekly-"wellness" visits to FP Ahnna Lake in Stowe, VT, paying $110 out of pocket for each hourlong session.
Lake describes herself as a "medical advocate." Although she'll prescribe medications or tweak existing prescriptions, she spends much of her time helping patients unravel the problems that keep them from feeling their best. She'll address any aspect of life that may be a drag on her patients' health.
For Riverton (not his real name), 53, the complaints include allergies, stinging eyes, chronic bronchitis, sinus problems, and bouts of depression he attributes to his exhaustion and Type II diabetes. But he wants more than symptom relief. What he's after-and willing to pay cash for-is a state of health best described as "thriving."
Riverton is not alone in his pursuit. A December 1995 survey by market research firm Find/SVP, titled "Changing Patterns in Fundamental Patient Attitudes," estimated the US market for self-help products and services at $1.4 billion. The growth in consumer spending in this area, the authors found, "is sharply outpacing that of traditional pharmaceuticals."
Patient interest in wellness isn't new, of course. What is new is that a small but growing number of mainstream physicians are making optimal wellness the central goal of their practices. They're creating innovative programs designed to help patients make healthier choices. They're talking with patients about issues, such as career satisfaction, that seldom get addressed in the exam room. And they're striving to teach wellness by example.
"We're still doing the traditional things we've always done," says GP G. William Hettler, co-founder of the National Wellness Institute and director of health services for the University of Wisconsin-Stevens Point. "But there's also a call to mentor patients, to help them pursue wellness on their own initiative."
Many physicians have responded to that call. Like Fairfield, OH, general surgeon Vijay Jain, who used visualization and meditation to heal himself of adult-onset polymyositis, and now shares his self-care strategies with patients. Could such physicians be raising the bar of patient expectations? Time will tell. Meanwhile, here are three in the forefront of the wellness trend.
FP AHNNA LAKE:
Working as a "wellness strategist" FP Ahnna Lake always knew she wanted to practice a brand of medicine that emphasized wellness and preventive care. After completing her family medicine residency at McGill University Faculty of Medicine in Montreal, she was more convinced than ever.
"I was burned out," she recalls. "I knew I was in a health-crushing system and that there was a healthier way to be a doctor." The picture her older colleagues painted was bleak: In order to make a decent income, she'd have to see too many patients in too little time.
Lake was also dismayed to find that most medical care came too late, after a person's disease was well-established. "I'm more interested in the vague complaints-the tiredness, the rising blood pressure, the nagging aches and painsthat show an early deviation from health," she says.
And so she decided to set up a very different kind of primary-care practice. Lake's approach is so new, there's not even a name for it. She calls it "medical advocacy," but the better term might be "wellness strategist." Half of her practice is devoted to counseling physicians on issues related to their professional wellbeing. She also sees patients with unresolved medical complaints, who already have a family doctor and may be under the care of one or more specialists.
"I try to provide patients with a relaxed environment that enables the two of us to carefully go over the current plan of medical care and build on it. I work to identify other factors that may be contributing to the patient's ill health, but have not been addressed," she explains.
Lake sets up those appointments after a 15-minute phone conversation with the patient. If she considers the problem beyond her expertise, she'll refer the caller to the appropriate specialist. During the usual hourlong visit, Lake asks for the whole story, including the person's feelings about work and personal relationships. She pays painstaking attention to diet, exercise, and other aspects of lifestyle, as well as the patient's emotional well-being. As Lake listens, she looks for the interrelation between symptoms and complaints, for the smartest way to untangle the knot.
If a patient says he doesn't have the energy to get out and exercise, for instance, she'll look for the root of the problem. "A surprising number of people are just not taking their medications properly," she observes. "A patient who complains of tiredness may be losing sleep because he isn't taking his allergy and asthma medication consistently. He's not likely to make that connection himself. Once you make sure he gets the proper blood level of medication, he'll sleep better and wake up with more energy."
That approach has made a real difference for dentist Wes Riverton. In the past year, Lake has reviewed several of Riverton's prescriptions and adjusted two of the regimens. The pillowcases she recommended to ward off dust mites "cost little, but made a heck of a difference," he says. And he was recently able to stabilize his blood sugar and stop his diabetes medication, thanks to her help with diet.
Lake, who's well-versed in the field of occupational stress, also helped Riverton address specific sources of stress in his dental practice. At Lake's suggestion, for instance, Riverton's receptionist no longer schedules complicated (and exhausting) procedures back to back. Lake also counseled him on how to talk to his patients, to minimize the emotional strain he feels when he has to perform a dental procedure patients find painful.
"I'm not out of the woods yet, but I feel I've taken some good steps to get a better handle on my health," says Riverton. "I have more energy, and I'm feeling better."
Not all of Lake's patients maintain the relationship for a year, as Riverton has. "I try to build independence," she says. "My goal is to transfer the knowledge, so the patient has no further need of my services. With some people, we can resolve the complaints pretty quickly."
Financially speaking, Lake is happy with her practice. "People are finding the money for all kinds of non-traditional care," she says. She earns enough to lower her fee for patients who can't afford the usual $110 an hour.
INTERNIST JOHN La PUMA: Cooking up healthy answers
As director of his hospital ethics center, Chicago internist John La Puma saw people who were so ravaged by disease that they were barely holding on to life. He wondered whether there was a way to prevent that kind of suffering. And he felt that he wasn't making the sort of difference he wanted with his own primary-care patients.
So La Puma began studying nutrition as a means of preventing disease. Trouble was, his patients rarely followed his dietary advice. That's when he hit on the idea of going to cooking school. "I wanted to see if it was possible to make flavorful, satisfying meals out of ingredients most of my patients considered rabbit food," he says. La Puma learned to create plant-based meals with "juicy, bright flavors," rather than heavy, oily ones.
The approach worked, in more ways than one. La Puma shed 30 pounds of excess weight, taking off the last few the year he left practice to attend cooking school full time. When he returned to practice a year later, he began handing out recipes on prescription slips, along with the usual prescriptions. Since many of his patients were overweight, he decided to take matters a step further and created a pilot program called CHEF (Cooking, Healthy Eating, and Fitness) at Alexian Brothers Medical Center, a hospital-based system in Elk Grove Village, IL.
CHEF is a 21-week program that combines five different weight-management strategies. During the approximately 60 hours of classwork, participants learn how to shop for healthy foods, cook nutritious meals, and order satisfying, low-fat fare in restaurants. An exercise physiologist helps patients create personalized fitness programs. A holistic nurse teaches relaxation techniques and guided imagery so that patients can understand when they're eating to fill an emotional need, and learn how they might better meet that need.
"I designed the program knowing that many of us work 60 to 70 hours a week, have families at home, and lots of pulls in all directions," says La Puma. "This program gives patients tools to do what they already know they should be doing. It tries to meet people where they live."
What results has CHEF produced? In a pilot study, five of eight patients who completed the protocol lost an average of 24 pounds, maintained 75 percent of their weight loss, reduced body fat by an average of 10 percent, lowered their triglycerides, and were still exercising 30 to 45 minutes a day, five days a week, six months after the program ended. Even more significantly, the five continued to reduce their percentage of body fat in the six months following the program, achieving another 4 percent loss. Their triglycerides also dropped another 12 points in that follow-up period.
La Puma is starting a second group this year and pursuing plans to create a trainer's program, using grants from Alexian Brothers and the American Medical Association. (For more information, contact La Puma at 847-956-6433 or 312-642-1553.)
GP G. WILLIAM HETTLER: Creating a healthy foundation for youth G. William Hettler, a co-founder of the
National Wellness Institute, is considered a dean of the movement. He devotes 40 percent of his professional life to his medical practice at the University of WisconsinStevens Point, and the rest to speaking engagements, teaching, consulting, program development, and-most recentlyhis Web site (wellness.uwsp.edu/health_service/staff/healer/autohett. htm).
Hettler is aiming for nothing less than a cultural shift. "There's nobody out there today who doesn't know the main risk factors, unless they've been in a coma," he says. "But facts don't change behaviors. Cultural norms change behaviors."
Hettler's university practice allows him access to young people, who are more likely to respond to efforts to mold healthy behaviors. One course he helps teach, "The Healthy American," draws about 800 students each semester. They learn a variety of assessments-such as blood pressure, flexibility, grip strength, and percentage of body fat-to gauge their well-being. They're required to submit a log of their self-care efforts.
"It's a very active introduction to selfcare," says FP Ahnna Lake, who is familiar with Hettler's work. "The part I love is the summer orientation, where he invites parents into the class. He asks them to stand up and then says to the students, `What you see standing here is what can happen to a healthy high-school senior, if you're not careful.' "
Hettler believes that well-being requires a balance among six different dimensions: social, occupational, spiritual, physical, mental, and emotional.
"Some people might be the last to intentionally work up a sweat. But they might be the first to talk about stress management or communication," Hettler says. "Once you help the patient establish success in one of the six dimensions, you can move on to others."
To smooth that process, he's seeking to build on the work of researcher and addictions clinician James 0. Prochaska on the stages of change people move through as they try to diet or quit smoking or drinking. Hettler wants to explore the impact of personality types on the stages of change in order to make physician counseling more effective.
"Authoritarian styles may not be effective for most patients," says Hettler. "I've heard physicians complain that wellness interventions don't work. I always wonder what they actually tried. Did they seek to understand whether the patient was ready for change-or what the patient's particular learning style was? Or did they simply give some directives on their way out of the exam room?"
Hettler says the field is wide-open for physicians who'd like to become more involved with wellness initiatives. He's confident there's money to be made. "Physicians are asked every day to certify that someone is healthy enough to handle a weight-loss program or exercise class," he says. "The fact is, people are willing to pay money to improve their lives. It's big business. Doctors need to get over the mentality that they can't perform a service if insurance doesn't cover it. They have to recognize that they can compete on the open market for patients' time and money."…
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication information: Article title: For These Doctors and Patients, Health Means "Personal Best". Contributors: Grandinetti, Deborah - Author. Magazine title: Medical Economics. Volume: 75. Issue: 18 Publication date: September 21, 1998. Page number: 82+. © Advanstar Communications, Inc. Jan 23, 2009. Provided by ProQuest LLC. All Rights Reserved.