Thursday, February 7, 2013

Physician Help Heal Thy Stressed Patients


The American Psychological Association released their 2012 survey of Stress in America and in it are some pretty interesting statistics, considering the current state of stress in our culture and its newly-appreciated place within the mind-body model of medicine.

Currently, I find that medicine shares something with truffles; you pay a lot and you get a thin slice. The current state of affairs in many medical practices is determined by the reimbursement the practice can get per day. It's also very much like what restaurants do and their philosophy of having to "turn the table" every half hour or 20 minutes or whatever. In medicine, it's 15 minutes for a regular visit, many times, or 30 minutes for what will be coded as an extended office visit. This means you said something more than "Good morning, Dr. I'm here for…"

How long have we known that stress is incredibly important in our maintaining our health, both physical and mental? How long have we known about the mind-body connection? How many times have we been told that stress is a killer and that the Japanese even have a word for work stress that kills? How much more information do we need on stress? Well, obviously, we don't need more information.  What we do need is more time with our healthcare providers in terms of helping us manage stress.

A number of years ago, while I was working for a major public relations agency that had multiple pharmaceutical accounts, I had to pitch a project and to prepare myself I needed to do a bit of research. The project dealt with diet and obesity and I wanted to find out how much training physicians receive in medical school on diet and weight maintenance. So, I called a few of the major authorities in the field and I was shocked to discover that out of something like 40 medical schools many of them gave a one hour lecture on the topic and the rest just left it out of their curriculum. Now, to whom are we sent when there is a problem regarding diet and obesity? Don't we always hear the recommendation, "Call your doctor." If your doctor doesn't know, of what use is it to call? And if your doctor does know something about it, where did that information come from?

So, if we accept the fact that stress must be a component of any healthy lifestyle and that physicians should be very much involved in helping us manage it, what is happening? The APA report indicates 53% of Americans "say they receive little to no support from their healthcare provider in managing their stress." Not only that, but 35% of adults "say their stress has increased in the past year and 33% say that they never discuss ways to manage stress with their healthcare provider.”

If stress kills or causes major medical illness, and we do know that it undermines the efficiency of the immune system, what is happening in the wonderful world of healthcare? Why isn't there more consideration and effort put into helping patients with the incredible stress in their lives? Is it a question of reimbursement? If it is, can't patients be referred to stress management programs?  Or is there no reimbursement code for that unless someone has a chronic heart condition? I know I'm being a bit acerbic here, but I think it's called for.

Not only did people not have an opportunity to share with health care providers, the topic was never broached, even those living with chronic illness (51% of them) see their healthcare provider three or four or more times per year. That would seem to present adequate time for stress management information.

What are the areas that cause the greatest amount of stress in people's lives according to the survey? Sixty-nine percent indicated it was money, 65% said work, 61% pointed to the economy, 57% said it was from family responsibilities, 56% indicated relationships, family health problems were noted by 52% and personal health was a concern of 51%.

So how are people trying to manage stress on their own, since they are not receiving any help from their healthcare providers? Many of them indicate they suffer from insomnia (not actually a way to manage stress), 36% engaged in overeating or unhealthy eating (we know that fatty foods and carbohydrates can be soothing). 

But some of them have come across things that really do work and that are not unhealthy.  Listening to music (48%), reading (40%) and 34% said they watched TV or movies more than two hours per day.  Thirteen percent turn to alcohol to manage their stress and 52% now turn to some form of exercise. This new-found interest in exercise is up from 47% in 2011.

Remember the last time you had to go to your physician's office and you had to wait for a real long time? Perhaps it's because they are double or triple booking in order to make sure that, if someone doesn't show up, they will still be able to make their allotted income for that day. While you're sitting around waiting, maybe it's a good opportunity to do some of that simple exercise that can help with not only that stress of waiting but the rest of the stress in your life. Walk around the office, walk in place, walk up and down the stairs. They may, of course, think you're a bit hyperactive, but just tell them you're trying to manage your stress since you're not getting information from anyone else on this. See how that goes.