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By Molly Mettler, MSW
Senior Vice President
Healthwise, Inc., Boise, ID
The graying of the baby boom generation has been likened to an "age wave" that will engulf and forever change the landscape of American health care. Your article heralding the onslaught of baby boomers, "Physicians need new skills for boomer demand" [Physician’s Managed Care Report, January 2001], paints a challenging picture for physicians. Confronted by a new type of patient with heightened expectations of customer service (". . . they’re demanding, they’re outspoken, they want hard, cold facts . . ."), you urge physicians to call upon nurse practitioners and physician assistants to help lighten the load. You also suggest that physicians look to disease management as a cost-efficient means to improve outcomes.
Making better use of allied health professionals and employing disease management models (which, as your article points out, physicians don’t have the time or the wherewithal to implement) are two good suggestions, but they hardly mark the starting point from which physicians need to begin. The two together make for a tiny, vulnerable life raft in a mighty rough sea.
Look instead to ride the age wave by embracing what baby boomers and older adults can do for themselves and for one another. Make them your partners in care. Embrace these new feisty, educated, and discriminating consumers. Put them at the center of your health care team, and they become your allies.
Step 1. Teach self-care. Empower and educate your graying patients (in truth, all of your patients) to become active and informed providers of their own care. Fully 80% of all health problems are treated at home in people’s bathrooms, kitchens, and bedrooms without the intervention of a health care professional. Give people the tools to practice good self-care, and they do just that: They provide good care in the home, and they reserve their office and emergency room visits for those health problems that demand professional medical intervention. The self-care guide Healthwise for Life: Medical Self-Care for People Age 50 and Better is one such tool. In one Healthwise for Life impact report, 38% of the participants reported fewer doctor office visits; 14% indicated that they avoided hospitalization; and 46% said they were better able to maintain their health and quality of life.
Step 2: Teach chronic disease self-management. Yes, as we age, we are more subject to the vicissitudes of chronic illness and the complexity of comorbidity. But that doesn’t mean people have to become any less capable of participating in their own health care.
Remember the adage: Give the people a fish and they have one meal. Teach them to fish and they are fed for a lifetime. It’s time to teach patients systematically and supportively how to care for themselves. With their Arthritis Self-Management Program, Drs. Lorig, Holman, and Mazonson and their colleagues from Stanford University demonstrated that costs go down, outcomes improve, and health satisfaction goes up when people with arthritis participate in their own care. Pain declined a mean of 20% and visits to physicians declined 40%, while physical disability had increased 9%. Comparison groups did not show similar changes. Estimated four-year savings were $648 per rheumatoid arthritis patient and $189 per osteoarthritis patient.
Step 3: Provide "information therapy." Information therapy is the prescription of specific medical information to a specific patient to help manage a specific problem. The rise of evidence-based medicine and multiple technologies for delivering personalized messages means we can meet baby boomer demands for individualized attention, 24/7 service, choice and control over treatment options, and access to the best information. Information therapy can be prescribed, just like a pill. The clinician selects from a huge array of options the right information in the right dose and in the right formulation to best help the patient. Rather than being a hit-or-miss optional service, information therapy will become a standard part of every clinical visit and service.
Step 4. Make a move to group appointments. A few years ago, Edward B. Noffsinger, a health psychologist at Kaiser Permanente’s San Jose (CA) Medical Center, had an epiphany about how physician practices were going to unfold over his career. Doctors could either continue to see chronically ill older patients one at a time and repeat the same words and actions over and over again, or they could bring similar patients with similar concerns together and, with a team of other providers, address their concerns as a group. (The clinicians provide individual attention as needed.)
Wonder of wonders, the patients greatly enjoyed the new model. Not only were they satisfied with the care they received; they particularly liked the social connectedness fostered by group appointments. The patients helped one another solve problems and lent one another emotional support. If physicians are too busy and too overwhelmed to meet the psychosocial needs of their patients, they can rely on the wisdom of patients who have been there and know what it means to cope with illness. As Thomas Jefferson astutely noted, "Who then can so softly bind up the wound of another as he who has felt the same wound himself?"
To build a sturdy ship in which to ride the age wave, physicians need creative and compassionate approaches to working with their aging patients. Your recommendations do not provide the durability that medical practices need to succeed. It’s not enough to add staff as a "first line of defense" (which focuses on supply management rather than demand management), to implement piecemeal disease management programs that physicians don’t have the time to implement, and to lament that baby boomers are disagreeable and overly demanding. The challenges before us require that we all recognize older patients as powerful providers of care in their own right, with a wellspring of wisdom and experience that can come only from the sheer exercise of living and surviving. To add value to your own practice, recognize where the value lies. Invite your senior patients to be your partners in care.
[Editor’s note: Molly Mettler, MSW, is senior vice president of Healthwise, Inc., and chair-elect of the National Council on the Aging. She is co-author of Healthwise for Life and is currently working on a book about information therapy. Healthwise is located at 2601 N. Bogus Basin Road, Boise, ID 83702. Telephone: (800) 706-9646.]