Unveiling the rise of deaths of despair [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

Join us on this episode as we welcome Mohammed Umer Waris, a family medicine resident, to discuss the alarming rise of “deaths of despair” and its impact on life expectancy in the United States. Umer sheds light on the factors contributing to this distressing trend, including substance abuse, mental health issues, and the decline of social connections. We explore the role of loneliness and its implications for overall well-being. Discover how medical professionals, like Umer, are diagnosing and addressing the social aspects that contribute to despair-related deaths through innovative practices such as “social prescribing.” Together, we delve into the importance of community engagement and personal responsibility in overcoming these challenges. Tune in to gain insights into the complex societal issues behind the decline in life expectancy and explore actionable steps towards building stronger, more connected communities.

Mohammed Umer Waris is a family medicine resident.

He discusses his KevinMD article, “Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy.”

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

With a growing physician shortage, increasing burnout, and declining patient satisfaction, a dramatic change is needed to make health care more efficient and effective and bring back the joy of practicing medicine. AI-driven ambient clinical intelligence promises to help by revolutionizing patient and provider experiences with clinical documentation that writes itself.

The Nuance Dragon Ambient eXperience, or DAX for short, is a voice-enabled, ambient clinical intelligence solution that automatically captures patient encounters securely and accurately at the point of care. Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 83 percent of patients say their physician is more personable and conversational.

Rediscover the joy of medicine with clinical documentation that writes itself, all within the EHR.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/2NMnes

Powered by CMEfy.

Transcript

Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Umer Waris. He’s a family physician. His KevinMD article is titled “Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy.” Umer, welcome to the show.

Mohammed Umer Waris: Thank you, Dr. Pho. It’s such a pleasure. I’ve been a fan of your website for so long, reading it since my high school days, so what an honor it is to not only have my article published but to now be speaking with you. So thank you for this honor.

Kevin Pho: Oh, well, thank you so much for writing. And I understand you recently completed residency, so congratulations to you.

Mohammed Umer Waris: Thank you.

Kevin Pho: All right, so before we get into your article, just briefly share your story and journey to where you are.

Mohammed Umer Waris: Well, I was born and raised in Southern California and then moved up to Sacramento for my medical education at UC Davis, and then residency in the area as well, and now consider Sacramento my home. And the big reason for my journey into medicine was being involved in the care of my grandparents, my grandfather in particular. My grandfather was the one who raised me, and being a part of his appointments, being a part of his care, particularly in primary care, and then seeing the difference that they were making in his life, and then indirectly in my life, because he was caring for me, left a profound impact on me and on the type of difference that I wanted to make.

And it wasn’t just that, but then the interest, the mentorship, the encouragement that they took in me and in pursuing my goals was a strong reason why I felt the interest and the ability to then go on and pursue a career in medicine myself. And I’ve never forgotten that. It goes to show, at least from my own example, how powerful words of encouragement can be, particularly for young minds in pursuing and shaping their path.

And then it also has shaped the type of physician that I wanted to be, because here were these primary care physicians that were caring for my grandfather but then were actively taking an interest in his life, in what was meaningful to him, by mentoring me. And that became one of my key lessons of how I wanted to practice medicine. The physician I wanted to be was not just focused on the disease and the prescription and the pills, but on the whole person, what is meaningful to them, their relationships, and contributing in whatever way you can, because that is significantly a part of that therapeutic alliance, that healing relationship that goes into making the lives of our patients better, improving their health, and then, who knows, shaping the careers and the paths of other generations as well, as it did for me. So that’s been how I got into medicine, my upbringing, and how I come here today.

Kevin Pho: As you know, fewer and fewer medical trainees are choosing primary care as a career. What’s the one reason why you decided to go into primary care?

Mohammed Umer Waris: I think it’s a point well taken that we are facing a shortage of primary care physicians. But we know that that, in public health, is the backbone of any good health metrics and of the health of a country in general, and it’s unfortunate that we’re facing this shortage. For myself, I think a big part of it, as I mentioned earlier, was the mentorship that I got from such physicians very early on, and then continuing on throughout undergrad, medical school, and onward. And it was, again, the impact that I saw they were making in the lives of my own grandfather, and then, as I was going on, in the lives of patients, and being able to develop that meaningful connection with patients, that meaningful relationship that goes beyond the disease. I thought that was happening significantly within the primary care setting. I’m not saying that it can’t happen in other settings, but I saw it personally, up close and center, and the impact of it in primary care.

And for somebody who’s concerned about public health, and we’ll talk about the deaths of despair obviously later on, I honestly felt that if I was going to be a part of the emerging crises of health outcomes, of disparities, from a public health and primary care background, I would have the tools and the relationships, significantly through relationships, through those challenges. And hence I was drawn to primary care, the people in primary care, the mission of primary care. And I certainly hope that the idealistic and passionate medical students right now will hear that and strongly consider that.

Kevin Pho: All right, let’s talk about your KevinMD article, “Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy.” So tell us, how did your article come together?

Mohammed Umer Waris: You know, Dr. Pho, I think it was that I follow the headlines very closely around health and health outcomes. And this was even prior to the COVID pandemic, but definitely accelerated during the COVID pandemic and afterwards: headlines of decreasing life expectancy in the United States, reversing decades-long, century-long trends where it had been increasing. And for the first time in our history, we have seen a historic decline where our life expectancy is now lower than it ever was since the mid-1990s.

And then alongside of that, you’re seeing headlines that have to do with the increase in youth mental health crises. The amount of pediatric hospitalizations due to mental health crises is increasing. You hear about drug overdoses increasing. Surprisingly, fentanyl overdose is now the leading cause of mortality in patients ages 18 to 45, overtaking motor vehicle accidents. That, to me, was shocking. And then you also hear headlines about alcohol overdose deaths and alcohol-related disease deaths, all of these rising.

And as I was reading more and more into it, I found that these deaths having to do with drug overdoses and also alcohol-related ones could be broadly termed deaths of despair. They were given that term by Princeton economists who had also been seeing the similar rise, once again, even preceding COVID, the rise of these types of deaths. But then they had also been rising at another time in our history, and in the history of Western democracies in general, in the past, about 100 to 150 years ago. And the sociologist by the name of Emile Durkheim, who’s considered the father of sociology, also categorized deaths and spoke about those deaths nearly 100 to 150 years ago. And he said that these deaths have a strong link to the breakdown of communities, of meaningful connection in people’s lives, to the loss of economic opportunity, to the loss of dignity that he had seen happening 150 years ago during the precipice of the Industrial Revolution.

And as I went into that research, seeing that, oh, these deaths are once again on the rise now, I tried to talk briefly about some of the social phenomena that may be contributing. Obviously, this was a health-related article. I couldn’t go into sociology as much, and perhaps wouldn’t need much more space to do so. But I didn’t mention the epidemic of loneliness.

And what’s fascinating now is that on May 3 of just this year, the Surgeon General himself released a public health advisory calling loneliness our next public health epidemic. And I mentioned this in my article, that this is on the rise, and it can be significantly tied to our health outcomes, to these deaths. And the Surgeon General right now himself, with the preponderance of evidence, comes out and says that loneliness is an independent risk factor for all-cause mortality, for all diseases, and it can be as much of a risk factor as, if not more than, smoking 15 cigarettes per day. So that’s how much of an impact it can be having on our lives.

And then I conclude that article by saying that, hey, this is an epidemic. This is an issue, the issue of declining community, that goes beyond just health care professionals. Obviously, we have a role to play within our clinics, connecting people through not just health care services but social services and community. We have a role. And then I also talk about government playing a role, which obviously Dr. Murthy is already doing a wonderful job of now by releasing the public health advisory. But then there is the role we as individuals outside the clinic, as citizens, have in strengthening our community, being involved in our community, in the lives of the people around us. That is so necessary and is going to shape health outcomes, and it is needed, because the decline of it is already shaping health care outcomes for the worse, in the form of these deaths of despair rising.

And so this is where the article came from, the impetus behind it. And then, going back to your earlier question about primary care, why it is a foundational aspect of the response: because there are few other settings where those relationships are being formed and counseling on community building is being done than in the primary care setting. The lifestyle modification, which I would consider community building to be a part of, can be done in the primary care setting. So that is where the article came from and what it hoped to accomplish.

Kevin Pho: So let’s talk about paths forward. And you mentioned different tiers of paths forward. You have approaches from a policy, governmental level, you have approaches from a clinician level, and approaches from a citizen level. So go into these three categories in terms of what are some of the options that we can use in terms of addressing these deaths of despair.

Mohammed Umer Waris: A wonderful question, and I think we all need to be asking this question, individually and as a society, because this is what it’s going to take. Beginning with the health care response, we need to be thinking about our patients, that they are, once again, more than just the disease that they’re coming to be diagnosed and treated for, but essential members of our community that we need to ensure are connected in our larger community.

And that goes to the concept of social prescribing, which is now taking on more and more research and evidence and a push for it, where we are not just connecting our patients to the next specialist, to the next psychosocial intervention or psychological intervention, not just connecting them to the next health care intervention, as important as that is, and as undoubtedly that must always still continue and will continue. But we also need to be finding and building partnerships in our community, whether it is with organizations that are volunteer organizations, community gatherings, activities of mutual interest, or faith-based organizations, where people are finding fulfillment, meaning, and connection that is so essential to their lives, and having those partnerships set up, having those resources set up within our clinic to be given to our patients, so that they can go out and be a part of them once they leave the clinic.

But then also, to whatever extent possible, we can help facilitate that within our clinic. There are multiple research projects right now showing that community clinics down in Europe have established gardening programs. That becomes a way for the patients to find community, and a garden at the clinic itself has been a significant part in establishing that. We know about group therapy, in particular for mental health, where patients are coming together and being counseled together and forming this network and support group, with a doctor or a support member facilitating discussion around mental health, but also around diabetes or other chronic conditions. And these are just some of the ways that our clinics and our providers can start building connections and facilitating connection.

Another thing that I think we must consider, and this actually comes from the Surgeon General’s public health advisory, is that just as we have grading scales and screening tools for depression and anxiety, the PHQ-9, the GAD-10 score, we need to have scores and scales for loneliness and isolation as well within our EMR, and have that be a part of our primary, secondary, and tertiary prevention strategies. That might be, hey, maybe it is just on that initial visit, but we get a sense of what your loneliness and isolation scale is, have that measured, and if it is high, have that be tracked over time and be a part of the interventions to address this as well. And right now, obviously, we don’t have those tools in our EMR, but I hope with this effort that the Surgeon General has done, and hopefully with this article, that we can have that be measured for our patients and then have that be a part of our prevention strategy for disease and well-being.

Going to the second part of the question as well, government and citizens. I think government absolutely has a significant role to play, because if there is any instrument of collective will in our society, it is our government, the governmental bodies, and them taking a stand, raising this as a crisis, mobilizes the collective will. And I’m very grateful to say that within just the past month, or even within the last month, the Surgeon General is already doing that. Now it’s a matter of us taking the recommendations from his public health advisory, and government at all levels, local, state, and federal, putting in the time, money, and effort to put those recommendations into play, and I think that is happening as well.

Finally, to your point, as citizens, and this is something that I’ve thought about for my own self personally and I share with others as well, we also need to look at our own lives. What is the time and the energy and effort we are putting in individually in our own lives to nurturing the essential connections around us that are important to us and are important to others as well? So many times in medicine, we are so engrossed in our professional goals, and necessarily so, because it takes so much of our time and effort, right? And particularly in residency, it takes so much time and effort. But I want us to recognize how our personal connections are just as important, just as much, if not more in many cases, than sometimes even our professional growth.

And I say that because the Harvard happiness study just came out recently, looking at the data of Harvard graduates. These are highly successful individuals that have graduated over many years, 30, 40, 50 years, and it monitored them, tracked them over time, and at the end of their lives asked them what they were most happy about, what they felt were their greatest successes. Overwhelmingly, almost unanimously, all of them said it was the relationships that we built. That is a part of our happiness.

And so for us, as citizens, even as health care providers, as private citizens, for our own selves, are we giving that time to nurture these connections that will be a part of what we are most proud of at the end of our lives, but at the same time, we know, are going to be what others are going to use for their own health and their well-being? And I gave that example of those primary care physicians for my grandfather, what a role they played for me in getting to this point. I can only imagine, if I didn’t have those interactions early on, where I would have been. And hence, for all of us as citizens, are we playing a role, a meaningful, loving, kind, nurturing role, in all of the relationships around us? I hope that we can take that on as citizens as well in building the community that we need.

Kevin Pho: He’s a family physician. His KevinMD article is titled “Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy.” Umer, tell us some specific things that your fellow primary care physicians can do in the exam room to perhaps move the needle and address this issue.

Mohammed Umer Waris: Wonderful. I think, as much as we can, let us be advocates at a systems level and say that we need to be tracked and monitored, and we have the tools to do that. There is the UCLA Loneliness Scale. There is the Berkman-Syme isolation scale. All of these are monitoring tools, just as we have the PHQ-9 for depression and the GAD for anxiety. We have these tools, these scales, that can be incorporated in our EMRs and used to monitor loneliness in our patients. And with that said, once we have that off the ground, and part of getting that off the ground is recognizing that, hey, social isolation is as much of a risk factor, an independent risk factor, for disease and mortality, just as smoking 15 cigarettes a day would be. And with that said, we push to have the tools to measure it in our EMR, and then counseling around that for our patients.

I don’t know how many times it’s been for me, Dr. Pho, but for so many others as well in the primary care setting, that we come across patients that are telling us, “Oh, you know, I haven’t spoken to my mom and dad in a very long time, or my siblings in a very long time, and so I really can’t provide you my family history.” Or, “Oh yeah, when it comes to social support, I have this friend and that friend, but we don’t always get together. But he is there. I’m sure he’ll be there if I need him.” So this is there. It’s been lurking underneath the surface, and it has already been taking a quiet but heavy toll on people’s lives, and it’s time for us to recognize it and start measuring it with the tools that I mentioned.

And then, just as we have in primary, secondary, and tertiary prevention strategies for, let’s say, diabetes, we talk about eating healthy, we talk about exercise, we talk about medication compliance. These are all part of the lifestyle modification counseling that we do. Can we include loneliness and social connection as a part of that? It doesn’t have to take too long, but it can consist of, “Hey, when was the last time you had a family meal together, uninterrupted by technology? Hey, are you part of any volunteer organizations, any faith-based organizations? Have you thought about that?” It could be as simple as having these questions posed, and encouraging and provoking thoughts about this and the importance of that, and the counseling around that: “Hey, this is a part of your health. Please consider being involved in this way, because it is part of your health.”

And then lastly, to the extent possible that we can also do this, can we consider social prescribing? Can we build those partnerships with our community that our patients can then be linked to, that we can give them those resources about, that they can then be involved in outside the clinic, and facilitate, even within our clinics, those group therapy sessions, right in and around disease, where they’re building a support network of common-minded people encountering similar common challenges?

So much of primary care, unfortunately, has become what so many have called the conveyor belt model: How many patients can you see? And that has taken away from the relationships that I talked about that drew us into primary care. That takes away from the time that we need to do the counseling, not just around loneliness but on so many other lifestyles, so on and so forth, to build that connection, to be able to do that well. So we have moved into that model where it’s just how many patients, how quickly can you see them? And can we take a step back and incorporate these new, innovative models of group therapy, making more time for counseling? And I think that will be the new groundbreaking era that we will enter upon in public health, when we take that approach, a relationship approach, a connections approach, and, as Vivek Murthy talks about, a connection-in-all approach to policymaking, in health care settings, in all settings. Once we do that, I think we’ll be at a breakthrough moment for public health, and I’m excited to be a part of that.

Kevin Pho: And my final question, just tell us some of your take-home messages that you want to leave with the KevinMD audience.

Mohammed Umer Waris: Oh, wonderful. I think for me, when all is said and done, it would be: Know that connections are a vital part of our own personal well-being. Let us make the time for them in our own personal lives, because it’s a part of our own health and the health of those around us. And let us encourage these conversations in our primary care settings, at all levels of society: Hey, what are we doing to strengthen our connections, to bring people together, to incorporate the values of kindness, love, compassion, social responsibility, and everything that we’re doing, at all levels of policy, of citizens, of health care, and in our own personal lives? And if we are doing that, I think we can have a breakthrough in this epidemic of loneliness. I think we can have a breakthrough against this crisis in life expectancy, and a breakthrough in resolving these deaths of despair and the mental health crisis, particularly among the youth, that we’re facing. I think if we take that approach at all levels of our own personal lives and society in general, we can make a huge difference.

Kevin Pho: Well, thank you so much for sharing your time and insight. Thanks again for being on the show.

Mohammed Umer Waris: Thank you, sir.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes