It Is Not Ok To Be Ok. You Have The Right To Be Well.

I guess its just a habit by now. Whenever I go to a major conference, such as the one I recently attended in our nations capital, I ask myself the question: What was THE take-away point? Mind you, these all-in-one type meetings are meant to cover the entire gamut of what is Internal Medicine, latest-and-greatest, for that particular year. So with literally dozens of hours of lectures from every sub-specialty and thousands of studies and facts presented to the average attendee, it can be a daunting task to find that one salient point that defined the entire week. This year it wasnt that difficult. In short, Dont settle for OK; explanation to follow.

A lot of what makes up the average day in a busy practice has to do with asking questions and receiving answers pertaining to the maintenance of whatever disease state the patient deals with, whether it be diabetes, hypertension, cholesterol elevation, etc. As youve heard me say many times, the bulk of what we do as internists is indeed maintenance. That is, with that all important participation from the patient, we try to keep the parameters that were tracking within a certain range thats set forth by national boards/committees/bodies that are made up of experts from all over the country (and the world, for that matter). So, for example, the National Cholesterol Education Program does just that: it analyses reams of data to determine the ideal range that we, the practicing physicians, should strive to achieve in our patients. As you can imagine, these standards undergo changes every so often and these meeting are great harbingers of whats in the tea leaves for the coming years.

Well, as expected, a lot of that information was available for us, but despite this juicy stuff, the driving point of the entire conference was that we were settling for OK. Said another way, we were/are allowing our patients to leave our offices with diabetes control in the OK range, despite knowing that strict control will lead to a longer life that will be higher quality to boot. The same hold true for hypertension, depression, etc. As one noted psychiatrist said, What are you guys waiting for?, referring to the fact that oft times a patients will tell us that theyre feeling OK after treatment and we, both patient and physician, settle for this instead of advancing treatment to obtain complete remission, which is always the goal. Another lecturer, who sits on one of those national panels I referenced above, poised the question a different way. An endocrinologist by trade, he kept referring to the orphan diabetics that walk around everyday seemingly controlled, but with no real parent to be strict about where they should really be. Complacency, anyone?

Sometimes it does pay to go after partial results. For example, now its a well-known fact that obese patients who loose as little as 5% of their body weight will reap huge benefits in all aspects of their lives. Going for the brass ring in this particular scenario is nice, but taking the baby-steps approach often produces more sustainable long-term success.

Save for situations like these, alluding to the parent metaphor above, most patients do indeed need a parent rather than a friend in a physicians office. Stricter control of these disease states will and do produce significant reductions in morbidity and mortality. This is not to say that your physician needs to be rude, crude and socially unacceptable. What it does mean is that he/she should enforce established guidelines with a more, shall we say, rigid approach. While that may seem a bit harsh, remember that the lower your blood sugar or blood pressure, the higher your good cholesterol, the less you use your rescue inhaler, etc., the longer you are likely to live! Its literally that simple. At the risk of patting myself on the back, my quality control parameters are pretty darn good, but they could be better if the rules that we know work were enforced a little more. That way, just like your kids will hopefully say one day, You know, mom/dad, I really didnt like it when you told me what I had to do, but now Im glad you did. I can only hope Im that lucky when it comes to my patients!

Sincerely,

Pedro E. Checo, MD, FACP
www.drcheco.com
469-633-9700