Wednesday, October 9, 2013

Population vs Individual Health: Forest for the Trees

Can't see the forest for the trees.  That expression implies that one is getting too caught up in the details to see the bigger picture.  But let's not forget that without those trees, there wouldn't be a forest!  I thought about this as I read the American Heart Association's Science Advisory published early online 2 days ago prior to print next month in Circulation in which the authors are pushing to reduce cardiovascular & cerebrovascular deaths by 20% while improving cardiovascular health by 20% in all Americans by the year 2020.

The focus is on both individual behavior (trees) as well as population behavior (forest), specifically the 7 cardinal sins associated w/cardiovascular health: smoking, diet, physical activity, body mass index, blood pressure, cholesterol & fasting sugar, each ranked as ideal, intermediate or poor.  On a population basis, it's scary and sad how few individuals are ideal in all 7 metrics.  And of those 7, optimization of smoking, diet, physical activity & body mass index could potentially prevent 4 out of 5 cases of heart disease, stroke & diabetes along w/2 out of 5 cancers.  

Can I do it alone?  No.  I need a team, the patient centered medical home (PCMH), where I can repeatedly Assess risk behaviors, Advise change, Agree upon an action plan, Assist w/treatment and Arrange follow up.  I can prescribe all the medications I want but the patient remains the boss and fully capable of out-eating & under-exercising any and all medications.  But now the drive is to incorporate all members of the office to help the patient see that his/her health is under his/her control.  I am but a simple navigator.  Think of me as your personal GPS (global positioning system) to guide you on your health journey through the forest of trees.

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