GE Moore MD's blog

According to Adam Smith, people make choices that serve their enlightened self-interest. Truthfully, people also make a lot choices that are unenlightened, but that’s a problem for another blog! Today, let’s examine the question of why an enlightened primary care physician (PCP) would choose to do wellness visits.

Well, like other businesses, PCPs need to do things that make more money…and wellness visits are the easiest path to making more money. How could that be - don’t doctors get paid for managing disease-care?

 In 1993, an intrepid group of exercise physiologists, physical therapists and one physician (me) drafted the first edition of a textbook called Exercise Management of Persons with Chronic Diseases and Disabilities (CDD). Working on behalf of the American College of Sports Medicine, we sought to fill a void of exercise guidelines for patients with chronic conditions beyond the “Big Five” (heart disease, high blood pressure, high cholesterol, arthritis and diabetes). Through 3 editions with a 4th now in press, CDD addresses nearly 50 chronic conditions.

Reductionism vs Complexity

Definitions

In Part 1 of false dichotomies, we consider widely divergent studies on the nature of Life. Each provides a different view of reality, somewhat like the way MRI “slices” are oriented in different planes to give different 2-dimensional images of a 3-dimensional organ, like a brain.

In the 1968 science fiction thriller 2001: A Space Odyssey, written by writer Arthur C. Clark and the film directed by Stanley Kubrick, the computer named HAL 9000 was touted as being incapable of error. In an infamous unintended coincidence, which Clark said he would have changed had he realized it, the letters H, A and L sit 1 position in front of the letters I, B and M.

A major flaw of the human mind is that it tends towards dichotomization - perceiving everything as two-sided: black vs white, hot vs cold, good vs evil, right vs wrong. The undesirable consequence is that we misperceive reality, which is extremely complex with many more than two sides. One only has to read the daily news to see the trouble this causes, but dichotomization also affects health care.

"Go Outside and Play"!

Those 4 words were often the instructions I got when I was young. And, apparently, I was not the only one who was told to come inside when the street lights came on. Or so I learned from Bill Sells and Tom Cove on March 4th, when they opened the Sports and Fitness Industry Association (SFIA) National Health Through Fitness Day, in partnership with the American College of Sports Medicine (ACSM).

When there are lots of ways to do something, it’s a good bet that none of them work. Everyone uses a technique or tool if it really is superior. So with the internet, bookstore shelves and junk mail bins filled by peddlers selling motivation...hmmm. Since getting patients activated – actively engaged in maintaining their health – is a huge element of plans to improve population health, it’s worth examining how that might work.

Dr. Ezekiel Emanuel published a misguided and extremely myopic op-ed in the New York Times on January 9. He recommended that everyone forgo annual physicals by their primary care physician (PCP). Annual physicals are often conflated with health checks or wellness visits, in which it may be appropriate to have a focused physical exam. A more constructive call would have been for Dr.

As 2015 opens, here are some thoughts on 5 challenges facing us in health care.

In prior blogs, I’ve written about the need for our heatlh care system to tear down the silos. One area of this is the use of health risk and social/behavioral assessments - what Sustainable Health Systems calls health ecology. There is lots of good activity going on in these domains, but it’s as if nobody is looking from the 40,000 foot view, and particularly not with the view of how the pieces will fit together when it’s all done.