The best medicine can only work when the patient is an active participant in the treatment as ordered.
The practice of medicine is evolving to what the medical practice field has known for a number of years: the brain and body are connected. We do not mean they are physically connected, nor are we talking about the mechanical functions regulated by the brain. We are talking about the thinking and behavior functions that originate in the brain and contribute to the health of our bodies. Though not rocket science in its complexity, it has been a challenge to incorporate into day-to-day practice.
Carving In
The concepts of thinking and behavior have been explored in traditional medicine for years, from both a medical practice and a payment perspective; those in the behavioral health field would talk about “carving in” (integration) or “carving out” (treating separately). Many practitioners chose the latter, driven in part by a general lack of knowledge of this interrelationship. But studies over the past 10 to 15 years have shown there can be both financial and overall health improvement benefits when treatment is provided in an integrated fashion.
A growing number of primary healthcare entities in the Peoria area have been exploring the means and challenges of implementing this integrative model, and they are still working out the kinks. Some of the challenges include reimbursement, payer rules and practices; some involves addressing the medical cultures in which providers work and are trained; and some of it is the nature of the change process itself: getting used to doing something differently than what was believed to be effective in the past. Research is demonstrating that educating consumers, providers, payers and medical school educators can positively impact the cost of care and the outcomes of overall health, while healthcare becomes more of a collaborative relationship between provider and patient.
The Patient Connection
This community is fortunate to have excellent providers who are skilled at assessing medical symptoms and prescribing effective treatments to improve our well-being. Frequently, the challenge is that the best medicine can only work when the patient is an active participant in the treatment as ordered.
How many of us don’t take our medication as it has been prescribed? Instead, we take the whole course of the medicine even after the symptoms go away; we don’t perform our 20 minutes of cardio four times per week or lose weight to reduce stress on our joints; we don’t actively participate in activities that help reduce stress in our lives. We are not being intentionally self-destructive, but until we have the internal motivation to implement what we are told, improvement may not occur.
Here is where the connection between the brain and the body is critical. It has nothing to do with a medical provider being a skilled physician; it’s that we may not be good patients, or we need some help to do so.
Working Together
In this battle, primary healthcare physicians are enlisting behaviorists—skilled staff who are teachers, coaches and motivators—to help. Behaviorists use motivational approaches to work with individuals to explore their health-related goals, the risks and benefits of change, and how to begin—in a realistic, manageable way. Choosing just a single behavior to modify can make a difference. Behaviorists teach cognitive behavioral skills that help individuals recognize what they think and feel about a change and learn how to increase the thoughts and behaviors that support the end goal. It’s important for individuals to identify the reasons they want to make a change and be prepared for—and realistic about—the change process.
The Milliman studies, released in 2012, have further identified some illnesses for which learning the principles of changing our behavior can improve treatment outcomes. Working together is the key, with all members of the medical team doing what they do best, including the patient. Each day, we continue to learn how to do this more effectively, knowing all individuals are different in their needs and in the approach necessary to maximize their health benefits.
Healthcare costs have been a bit of a runaway train over the past 30 years. This strategy is one that employers, insurance companies, the medical community and patients are beginning to embrace to achieve the Institute for Healthcare Improvement’s triple aim of improving the experience of healthcare, improving the health of populations and reducing the per-capita cost of healthcare. Our job is to take control of our own lives and direct them toward a healthy destination. iBi
