BE
Healthy ™
Sponsored by
Boston Public Health Commission
VOL. 4 • NO. 7
Te ap am re pr be su oa tt lts ch er in ca re
© March 2010
PATIENT POWER By all accounts, Donna Matthews is a “good” patient. As a diabetic, she checks her blood sugar level four to five times a day – and more if she does not feel well. She writes the numbers down in a log that she dutifully presents at each doctor’s appointment. Talk about patient empowerment. “I think I’m a little OCD (obsessive-compulsive disorder) now,” she admits. But that “OCD” serves her well. She can name each of her medications and the dosage. She asks questions; she writes things down. To say the least, Matthews is prepared — and clear on specific problems. The reason for her obsessiveness is also clear. “I don’t want to get any worse,” she said. The notion of patient empowerment — that patients take an active role in their care — is a growing concept. It’s not that patients are taking over; they’re just taking part. They weigh treatment options, learn about their illnesses and make decisions about their care. Research has shown that patients who interact with and have a good relationship with their providers not only receive better care but are happier with that care. If only all of Dr. Mark Drews’ patients were as good as Matthews. As an internist at Whittier Street Health Center, he averages
about 70 patients a week, and maybe he has specialists as well. twenty minutes with each of one of them. Dr. Eldrin Lewis, a cardiologist at Brigham and Women’s Hospital, admits he But a lot has to happen in those 20 minutes. spends more time in a visit compared to some. His visits also average 20 minutes but can Especially considering that primary care range as long as 40 minutes for new or comphysicians (PCPs) are increasingly being plex conditions. asked to do more with less time – and with fewer doctors. PCPs are becoming such a PH OTO BY TON Y IRVIN G rare commodity that in 2009 the Massachusetts Medical Society concluded that the shortage of doctors of internal medicine is “severe,” and that of family medicine is “critical.” Complicating the problem is that only 60 percent of family practitioners and a scant 44 percent of internists are accepting new patients, according to the society’s Physician Workforce Study. Donna Matthews (right), discusses her log of blood glucose levels with Dr. What’s worse, Mark Drews (left), a primary care physician at Whittier Street Health Center. on average, patients in this area have to Both Drews and Lewis agree that the time wait 44 days for an appointment. is better spent if patients come prepared. Although a 2009 report in the Archives “You wouldn’t think of visiting an accounof Internal Medicine found that visits with tant and asking if you’ll get a tax refund if you PCPs increased from an average of 18 minutes to almost 21 minutes, one thing remains have not provided the appropriate receipts,” Lewis said. “Why would you handle a doctor’s clear: there’s not much time behind those closed doors. visit any differently?” Time constraints pose a problem with Patient power, continued to page 4
The root of the problem Medical histories play an essential role in determining future lifestyles Thirty minutes had passed and Brenda Robertson had more questions than answers. She was trying to fill out her family tree — complete with medical histories — and she soon learned that the task was nearly impossible. Many of her relatives were dead and their medical histories — to the extent they were written down — died along with them. That didn’t deter Robertson. The information that she could collect was a good start — and changed her life. Both of her parents died from strokes, but it was her father’s history that particularly stood out. He had two strokes, and the second one was fatal. He was 44 years old when he died. Those genes were passed down. Already, Robertson’s older sister has had a stroke, as has one of her nephews. So far, Robertson has been spared, but she is not taking any chances. “I want to prevent these illnesses in myself,” she said. Knowing that strokes and diabetes run in her family, Robertson has changed her lifestyle
The value of family medical histories is enormous, largely because many illnesses are passed down from generation to generation. Many diseases, such as cancer, diabetes, high blood pressure and even mental illness, have a genetic link. So important is the family history that the Surgeon General in 2004 launched a Family History Initiative to encourage families to learn more about their inherited Knowing a family medical history can sometimes reduce the risk of health risks. The Surgeon inherited diseases through timely screenings and lifestyle changes. General designated to control those risks. Thanksgiving — a holiday when families She has substituted water for sugared gather — as National Family History Day. The beverages, reduced her portion sizes and eats Department of Health and Human Services has more vegetables. And she exercises. created a web-based tool at https://familyhis “I walk a lot now,” she said. tory.hhs.gov that allows users to enter, print out
and save the information. The family history tree is an essential tool for patient empowerment. In the 2004 HealthyStyle survey, the Centers for Disease Control and Prevention found that 96 percent of the respondents believe that family history is important for their own health; yet a paltry 30 percent reported that they actively collected necessary information. One difference was noted, however. Those with a personal history of type 2 diabetes were more likely to have collected information from relatives. The family medical history tree allows a doctor to assess risks for a certain disease, determine the type and time of screening tests and judge the risk of passing the conditions on to the next generation. For instance, women who have a history of breast cancer — especially when diagnosed at a young age — may require initiation of mammograms before the age of 40 as well as a concomitant MRI. Family history continued to page 4