In November, Stephen Schimpff, M.D., of Columbia, retired chief executive officer of the University of Maryland Medical Center, and considered one of the world's foremost experts on health care, presented a talk on "How to Be Your Own Health Advocate," including tips on combating chronic illnesses and getting the best health care possible. Held at Linden Hall, in Ellicott City, the session was sponsored by the Lutheran Village at Miller's Grant, a planned not-for-profit continuing care retirement community, being built in Ellicott City. I wasn't able to attend Schimpff's talk so I scheduled an interview with him.
Schimpff had three topics he wanted to discuss: What is involved in the normal aging process; can we slow the aging process; and how to get the best primary care.
Concerning the first topic, Schimpff said that almost all of our organ functions decline at a rate of 1 percent a year after age 35. This is a slow descent; and some people's decline is slower than others. There is a huge redundancy in organs, so we can afford the declines, without illness. Eventually a point is reached at which disease presents itself. Also, we all experience some decline in cognitive function, as we get older.
Schimpff said, "Yes, we can have an affect on slowing the aging process." He stressed the "big four" as a way to slow the process: good nutrition, exercise, stress reduction and no smoking. It is also possible to avoid or delay age-prevalent disease by following the "big four."
His recommendations are to eat fresh, frozen or home-canned fruits and vegetables; walking; weight bearing exercise; and balance exercise. The exercise will also help reduce stress. Smoking can have an adverse affect on heart disease, diabetes, chronic lung disease and kidney disease. He said that chronic diseases trace back many years to the "four" behavioral issues and dealing with these behaviors can slow the decline. In terms of cognition, the same 'big four' rules apply as well as being intellectually challenged and socially engaged.
For his book, "The Future of Health-Care Delivery — Why It Must Change and How It Will Affect You," Schimpff interviewed more than 150 people across the country and discovered a commonality: we have a dysfunctional health-care delivery system. The book includes a chapter on primary care, where he believes the real problem lies. The book "challenges patients, providers, insurers and employers to embrace new approaches including high deductible, wellness incentives and care coordination while explaining coming disruptive and transformational changes to health-care delivery."
The primary care problem centers on the time spent with the patient. Primary care physicians on average see two times as many patients a day compared to just a few decades ago; 25 to 30 patients a day is the system average. The average time for each visit is 15 to 20 minutes, with about 8 to 12 minutes of actual face time. In that short amount of time it is difficult for the physician to manage the patient's total health care. Schimpff recommends that older persons should find a primary care physician who will give them the time and the comprehensive, person-centered care they need.
Schimpff related a true story, which points out the importance of taking time with a patient. The physician detected something wrong with the patient's speech. A battery of tests showed no adverse health condition. He wanted to do an MRI but the patient's insurance company wouldn't allow it because the doctor didn't give a specific medical reason. After finally convincing the insurance company's management to allow the MRI, results showed a brain tumor. Without this doctor's determination to solve the medical problem and his persistence with the insurance company, the tumor wouldn't have been found in time. "If enough time is spent with the patient, so much can be found and taken care of," Schimpff said.
According to Schimpff, an important part of the doctor-patient relationship is the older adult's preparation of a written list of health issues/concerns prior to a doctor visit. Give the doctor a copy when you go in and keep one yourself. Make sure the list is in priority order and the health issue of most concern to you that day is number one on your list. You should also take a list of your medications, which should be with you at all times.
Also, make sure you have a list of your medical history in case of an emergency room visit or if you are going out of state. Ask your primary care physician to provide you with your medical history.
The primary care physician should be the patient's care coordinator, responsible for the patient's total care. The older adult should select a primary care physician who encourages a working doctor-patient relationship, which is key to achieving the best health care. According to a Rutgers University study, "When doctors are familiar with their patients — how they're feeling, what their concerns are, and what they do in life — they are more successful in meeting individual needs."
Even though he retired 10 years ago, Schimpff really considers himself "quasi-retired." He is professor of medicine at the University of Maryland School of Medicine, where he teaches residents and fellows in oncology and infectious diseases. He is also a professor of public policy at the University of Maryland, College Park. He researches and writes books, gives talks and blogs about the future of medicine and medical megatrends. To find out more about Schimpff and his health care expertise, go to medicalmegatrends.com and medicalmegatrends.blogspot.com.