Making My Patients ‘Healthy Again’
With a Make America Healthy Again Commission now in place, President Donald Trump has solidified his intention to shake up health care in the United States. The president, alongside newly confirmed HHS Secretary Robert F. Kennedy, Jr., has ignited national debate about why so many Americans are sick and what we as a country can do about it.
As a practicing physician, I feel compelled to weigh in.
Chronic disease is indeed rampant, with 60 percent of Americans living with diabetes, asthma, high blood pressure, obesity or a similar condition.
Forty percent of Americans live with two or more chronic diseases. Clearly the standard American diet does not serve us well. Encouraging people to trade out boxed foods for whole fruits, vegetables and grains would undoubtedly help.
Not all chronic diseases, however, are caused – or solved – by diet and lifestyle. I think specifically of my patients with rheumatoid arthritis.
For these patients, life is full of invisible pain. Joints flare and aches spread through the body—even patients’ eyes become irritated and dry. The condition can lead to disability and increased mortality if not properly managed.
Diet and exercise may help alleviate some symptoms of rheumatoid arthritis and even delay progression. Eating a nutrient-dense diet and engaging in physical activity have been found to promote “a reduction of inflammation, symptoms and disability.” Dietary changes alone, however, will not be enough.
As the 1.5 million Americans with rheumatoid arthritis know, the disease is not a consequence of poor lifestyle choices. It’s an auto-immune disorder that burdens patients well into old age. So how do we make these patients healthy again? And what about so many other people living with diseases fueled by genetics, environment or factors beyond their control?
My advice: we make smart, proactive use of the tools we must catch these diseases early and keep them under control.
For rheumatoid arthritis patients, that could include focusing on prevention. While rheumatoid arthritis is difficult to catch early, screenings can save patients and providers from the worst of the disease’s long-term burden.
We also can prioritize early treatment and avoid the pain and cost of late-stage intervention. One study found that the progressive course of the disease may be mitigated or changed when there is early intervention.
We can use the medical advances available, including innovative treatments like biologics, to pursue remission instead of asking for resilience. Prioritizing remission for patients is a sure way to make this patient population “healthy again.” By alleviating disease symptoms, remission transforms lives, reducing the struggle associated with daily tasks like gripping a coffee cup or buttoning a shirt.
Say a patient comes to me exhibiting early symptoms of rheumatoid arthritis. Perhaps she or he wakes up with stiff fingers in the mornings, has swollen joints and feels tired without cause. With a thorough examination, I can make a diagnosis and prescribe a medication to reduce the symptoms before they get out of hand. A patient at this phase, assuming that they maintain the prescribed treatment regimen and keeps up with regular medical appointments, has every hope for a good quality of life.
On the other hand, there are patients who visit only after symptoms have become unbearable. Pain and inflammation are persistent across the body and nearly around the clock. It’s not uncommon for me to discover that patients like these already have bone or cartilage damage. In some instances, the heart, lungs or other organs may have already been damaged.
Care at this phase is still worthwhile, but it will be less effective. And in terms of cost to the health care system, the damage already inflicted on the patient’s body could require a downstream cascade of specialist treatment, medication and even joint replacements.
At the individual patient level, making someone healthy again isn’t always simple. But at the population level, we can do a lot by adjusting our approach. By turning the focus to screenings, timely treatment and tailored care, perhaps physicians can use the energy behind Make America Healthy Again to deliver optimal outcomes and restore quality of life for their patients.
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Dr. Huffstutter is a rheumatologist in Hixson, Tennessee and past president of the Tennessee Rheumatology Society.