Stephen C. Schimpff is a quasi-retired internist, professor of medicine and public policy, former CEO, University of Maryland Medical Center, and senior advisor, Sage Growth Partners. He is the author of Fixing the Primary Care Crisis: Reclaiming the Patient-Doctor Relationship and Returning Healthcare Decisions to You and Your Doctor.
As a retired physician, I notice many seniors become skinny and weak due to muscle loss yet have big bellies as fat accumulates. They are less strong, less vibrant, and prone to falls and chronic illnesses like heart disease, diabetes, and cognitive decline. This does not need to happen, but many older people do not appreciate the health and wellness impacts of muscle loss …
There was outrage over the sudden rise in the price of the EpiPen. But the rise in many other pharmaceutical prices gets less attention but is just as concerning. It can be easy to forget issues like this until they affect us personally. My two encounters with irrational drug price increases for dermatologic conditions are a reminder of how pervasive this problem is today.
I have rosacea, a …
Part of a series.
We are all aging every day, but mostly we ignore, do not recognize or deny it. Then all of a sudden, we look in the mirror and realize that older age has found us. Even then each person deals with aging differently. There is Dr. Seuss’ “Cat in the Hat” who sees nothing but adversity in aging. There are others who accept aging but …
Part of a series.
A pill to end aging.
Is there or could there be such a pill? Some researchers think so.
Many believe that rather than attack the causes and treatment of chronic illnesses one by one, it would be better to understand the biology of aging and from that learn how to slow the process and hence prevent or delay the onset of various …
Part of a series.
Cognitive decline is a normal process of aging; Alzheimer’s is a disease.
Cognitive decline due to aging can be slowed but not halted with appropriate lifestyle approaches. The “big four” are equally important to slow cognitive decline: Don’t smoke. Reduce stress. Exercise often. And eat a quality diet in moderation.
Good sleep and brain stimulation need to be added for maintaining good cognition. Some form of …
Part of a series.
Can we slow the aging process? The answer is a definite yes. It’s not easy and requires some real diligence, but aging can be slowed.
When thinking about a car we all know “old parts were out.” It is equally true for the human body. But less appreciated is the fact that we can either slow or speed up the process, just as good preventive …
Part of a series.
Beginning at about age 40, our bodies begin a process of organ and functional decay of about 1 percent per year. Bone mineral density decline leads eventually to osteoporosis and fracture risk, cognition decline leads to memory and thinking impairments, and muscle decline leads to loss of strength while increasing the fracture risk of a fall.
According to the Centers for Disease Control, almost …
Part of a series.
The percentage of the population that will be “elderly” is rising fairly dramatically. In 1900 only four percent of the population was over 65 and only one percent over 75. By 1950 it was eight and three percent, respectively. By 2000 it was thirteen and five percent, and now it’s about fourteen and six percent. By 2030 it will be substantially more again.
There are many …
Part of a series.
For most of recorded human history, lifespans did not change.
Life expectancy doubled in the twentieth century. At the time of Lincoln the average life span was 38 years; today it is about 78 to 80 years. But whenever it ends it is like a waterfall. Most people begin to die near to the expected point; the drop off in percentage still living declines precipitously. Fortunately, …
Part of a series.
Those of you who have read some of my past posts are aware that I wrote mostly about various aspects of primary care and our dysfunctional healthcare delivery system overall. About 18 months ago I wrote a post for KevinMD on moving to a retirement community. More recently I became focused on the primary care needs of older individuals and from there got …
Part of a series.
Here is a model for the delivery of primary care which offers certain rights balanced by responsibilities for patient, provider and insurer alike.
First the rights of each party. As a patient, you deserve a high level of care in a satisfying manner without frustrations. The insurer and your employer want to see the total cost of health care come down. The physician wants the satisfaction …
Part of a series.
I have advocated in this series of posts on direct primary care in one form or another (i.e., membership, retainer-based, concierge and various other incarnations and conceptions) because it works well for both patients and primary care practitioners. Direct primary care allows the doctor the opportunity to give the type of outstanding care that each of us needs, whether currently healthy or beset with multiple …
Part of a series.
Primary care needs to change. That change will need the concerted efforts of patients, doctors, and other constituents. Many are cynical and believe that no worthwhile change can ever occur; others are simply resigned. But optimism can be realistic with intense advocacy and simply taking the initiative to make change. This may surprise you, but change will only happen when patients along with doctors become …
Part of a series.
Among Medicare recipients, those discharged from the hospital incur about a 20 percent risk of an unplanned readmission within 30 days. The number is higher for some conditions such as heart failure. This is the result of a terribly dysfunctional health care delivery system. Of course some patients will need readmission; the number can never be pushed down to zero, but 20 percent is appalling.
Why …
Part of a series.
You know the serenity prayer, written by Reinhold Niebuhr in about 1940:
God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.
I saw an elderly woman in the hallway recently with the prayer framed and done in needlepoint by her daughter. It was very beautiful, and it got me to thinking …
Part of a series.
We tend to think of the primary care physician (PCP) as the one who does the simple stuff, a doctor who is a mile wide and an inch deep in knowledge and experience. That is a false impression. By education and experience, the PCP is actually a chronic disease specialist.
That is, provided the PCP has the time to care for his or her patients with …
Part of a series.
Urgent care clinics provide a useful service to the community, but their days may be numbered with survival questionable resulting from intense competition from the chain pharmacies and soon from Walmart.
Urgent care companies began to proliferate 30 years ago but have gained traction in recent years as emergency room wait times rapidly lengthened. Urgent care is less expensive than the ER, is open 24/7 or …
Part of a series.
“It is all about vigilance and caring. Our aim is to put the caring back into health care and we are serious about that. Our standards are not how many patients did you see today but how much quality did you dispense today,” Dr. Greg Foti told me about the clinic where he works in downtown Baltimore, MD.
Individuals that have multiple chronic illnesses compounded by …
Part of a series.
Readers of my posts know that I am a strong advocate for primary care and for granting the PCP added time per patient. Older patients in particular with both their many impairments and chronic illnesses need more time per visit. Here is an approach by a continuing care retirement community developer/manager to assure that the PCPs have adequate time for each resident, most of whom …
Part of a series.
PCPs in the current reimbursement model are obliged for business reasons to see many patients per day which, of course, means less time per patient. PCPs are frustrated, and patients are less satisfied. With less time, it is hard to build a strong doctor–patient relationship and without it there is less opportunity to build trust. Readers of my posts at KevinMD know that I …
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