#4 -The Current Patient Population
Welcome to Health Interventions! A practice resource for NPs from brand new to pro. This podcast I’ll be sharing my thoughts on the current patient population.
■ The complexity of those patients
■ Contributing factors to that complexity
■ The beginnings of managing those complexities
■ ...and so much more!
Today we are talking about is our current patient population. The patient that you see in your office today, no matter what they seem at face value are very complex and have multiple underlying conditions lurking. This is a product of the world in which we live. Today’s society is one of increased stress, Processed foods, on the go living, lack of exercise and increased screen time. and that is just the tip of the iceberg for contributing factors to the ever-changing and declining health of our US population.
When you put all of these things together, it leads to the ever rising trend of obesity, which leads to hypertension, pre-diabetes, diabetes, hyperlipidemia, autoimmune disorders, obstructive sleep apnea, depression and so much more.
I try not to quote a significant amount of stats in this podcast, because I want it to be more about the learning how to manage these situations and the things that cause the situations than the analytical aspects of disease processes. We can all look up data, but putting it into the real world practice that leads to real outcomes is often a little more difficult. I however think it is important to say that between 2017 and 18 42.4% of the population was obese according to the CDC. To break that down.. The prevalence of obesity was 40.0% among young adults aged 20 to 39 years, 44.8% among middle-aged adults aged 40 to 59 years, and 42.8% among older adults aged 60 and older.
We learn about disease processes individually, and how to treat them. We do know that Obesity is now a disease because it contributes to other diseases. The definition of disease is ——— “a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms”.
The definition of Obesity is a complex disease involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It is a medical problem that increases your risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.
Add in the things that are happening at a cellular level outside of calories in and calories out … mind blowing!
It is way more than One would realize. The things that are creating the epidemic we are in right now with Obesity are part of what is driving my passion to educate other Nurse Practitioners. Because when we are able to treat obesity due to underlying causes, we are able to treat all of the other co-morbidities that I had mentioned earlier. It is just as much psychological as it is physiological.
The patient of today is sicker and sicker. As we’ve already touched on the body mass index being elevated is contributing to multiple problems and there is a lot of cost associated to it in healthcare. So, when we look at today’s patient that we are treating it is complicated. The effects of all of those things mentioned previously are piling up. Many times when you see a patient that has not been seeking care regularly you will have the diagnosis of diabetes, high cholesterol, and high blood pressure all at once. You will be handing them a new handful of medications to take, Based on the guidelines. Many of them will be noncompliant. Many of them will be in denial. Many of them will not tell you a lot of the contributing factors unless you asked specifically. And then you have your wonderful 15 minute slot to try to sort everything out and manage it.
In addition to the comorbidities associated with obesity there are environmental factors that are contributing to symptoms. It can be very overwhelming managing today’s patient. They will have not only the comorbidities mentioned but they will also have many symptoms and underlying conditions such as neuropathy, migraines, chronic pain and depression.
You have to be on your toes when treating today’s patient population. With everything that I have said in today’s podcast, I am leading into how I plan on helping you sort through all of these conditions and streamlining your management of the patients in an efficient, time conscious fashion. It can be done. You cannot treat just diabetes or hypertension or cholesterol. You have to look at the whole patient and you have to be able to give actionable plan of cares.
I do have an online program that guides you in offering weight management services in your practice to manage obesity and it’s related conditions. When you start with Obesity management you can knock off a lot of problems at once with the least amount of medications. And it’s not the same calories in calories out. It’s not as hard as you may think. It’s just a redirection of your thinking. So check that out on my webpage nphealthinterventions.com if that is something you are interested in.
We were taught disease management. Unfortunately, we have never been directed appropriately in preventing those diseases or reversing them. It is possible to reverse high blood pressure, diabetes and high cholesterol. As well as many of the other things that we are seeing in our patient population. We are currently allotted annual preventive appointments that have been no help at all. At least I don’t think so. You spend that appointment documenting your body mass index, the cholesterol and blood sugar levels, trying to identify comorbidities that you can treat, order their mammograms and other screening tests per age, but it does not allow you in that window of an appointment to get into any of the real issues..
Now let’s add that a lot of patients are getting their information from Dr. Google their nutrition information from Pinterest and advice on health and wellness from whoever is trying to sell them something with no medical training. I’m often surprised at the things that people will do because of what a friend told them or what they found on the Internet. Or from someone who is in multi level marketing. Don’t get me wrong, there are some very reputable companies with nutritional supplements, but I don’t think that the average person joining these companies should be giving medical advice. I’m sure they don’t say that they are giving medical advice, but to many of their customers it is taken that way. Then that patient comes into your office with a bag full of things that they have bought that is supposed to improve their health and ask you about your opinion on them.
How do you feel about that? Do you feel prepared to answer these questions?
Unless I am personally aware of the supplements they are taking I will not answer that. If it is not a pharmaceutical-grade company I will not put my stamp of approval on it. There’s a whole other episode where we talk about nutritional supplements and the additives that are placed in them that are more harmful than beneficial.
A few of my favorite resources for reputable supplements:
To give an example the big bottles of Omega/fish oil sold at Walmart, Costco or Sam’s Club have what I call the sludge in the ocean in them, including heavy metals and more omega-6 than omega-3. …Just for reference- omega-6 is pro inflammatory and can increase clotting factors rather than decreasing platelet aggregation as does omega-3. So, on that specific topic if you are recommending someone to take omega, which is very beneficial for anyone, insist that they get a good quality omega. You can direct them to reputable companies to order online if you don’t offer or carry those in your practice. If you don’t own your own practice, you may be limited with that kind of offering .
OK, so now we have talked about the increasing complexity of our patient population with multiple comorbidities that are linked to societal contributions for us to manage and the web/social media resources outside of your office that you have to manage.
Are you still with me? Hang in there. One other thing that I’m going to talk about and I will try to keep it brief. polypharmacy.
I don’t know about you, but I don’t want practice in a “here’s another pill” kind of way anymore. Think about it! There’s a pill for everything. And there’s a pill to cover up the side effects from the last pill.
How often do you take someone off of a medication?
Do you ever use medications that have more than one purpose so that you can eliminate maybe one or two of their other ones and have less side effects?
I’ve Got some strategies for you. We’re gonna work on that. But another time!
Thank you for reading through! Listen to all I have to say on this topic on the podcast! Subscribe so you don’t miss any. If you wish, You can find more of me on healthinterventions.net and the Health Interventions Facebook page where I do cooking demonstrations and health tips.
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