Living With Versus Living Better

Gilbert F. Douglas

Chronic disease doesn't usually come with the drama of a new miracle drug. However, with good management, physicians can make a positive difference for these patients.

Sooner or later, many of us will have to learn to deal with a chronic disease either in ourselves or in family members. Diabetes, arthritis, asthma, heart and kidney failure, fibromyalgia, Parkinson's Disease, and COPD are only a short sampling of the chronic disorders humans are heir to. By detecting warning signs early, in some cases physicians may be able to help prevent or delay onset of these maladies.

"With new management codes and a greater focus from insurers on helping patients stay out of the ER and avoid bouncing back to hospitals, we're putting structures in place so we can take the time to manage conditions proactively rather than reactively," Norwood Clinic primary care physician Gilbert F. Douglas, MD, said. "We don't have to spend all our time addressing only the immediate symptoms. Under Medicare guidelines, when patients have two or more chronic conditions with a potential for decline, they can qualify for twenty minutes or more a month of chronic care management services to establish, implement or review care and monitor the patient's condition."

To work effectively with this new care model, it helps to develop a plan to pinpoint patients who meet the criteria and could benefit from proactive management of chronic conditions. It is also important to have documentation systems in place to gather the data needed for reimbursement.

"Other members of the care team can be helpful in managing chronic disease," Douglas said. "I've been very impressed with our nurse practitioners. Before we even go into the exam room, they have reviewed medications and other details. It is surprising how often they find patients taking drugs prescribed by other doctors long ago that are no longer needed or may even duplicate or interact with their current medications.

"Nurses also excel at teaching patients. Chronic conditions can be complex, and it's important to help patients understand what they can do to take charge of their health. When patients understand what their prescriptions do and how to take them, they are more likely to comply with medications.

And depending on the diagnosis, your patient may need a physical therapist, occupational therapist, diabetes educator, nutritionist and perhaps psychological counseling. You need access to a solid team of professionals who can help your patients achieve the best outcomes."

Another vital resource for primary physicians is a list of specialists they can call on when they need a consult or their patients need a referral.

"I like working with specialists who will tell me straight up when unusual lab results are not significant and when patients need a more comprehensive evaluation," Douglas said. "Primary care providers see the big picture with the patient's health. We can manage many types of chronic diseases, but no one is a specialist in everything. Some conditions require more complex evaluation and specialized treatment. That's when you need to be able to call on the expertise of someone you trust."

Nop Unnoppet, DO

As a rheumatologist, Nop Unnoppet, DO, of Advanced Arthritis Care and Shelby Baptist Medical Center frequently receives calls from primary physicians.

"Often it's when labs come back with unusual results and they want an opinion on whether it is clinically significant," Unnoppet said. "Sometimes an elevated ANA only means that patients have autoimmune disorders in their family tree. I ask about symptoms to determine whether what I'm seeing in labs is being expressed physically.

"Rheumatologists by definition work with chronic disease patients. Many different disorders come under that heading, and the first thing I have to do when a patient comes in is determine whether their symptoms come from an autoimmune process or from years of use."

"Is it inflammatory or noninflammatory? Can a patient's pain be cured with a knee replacement? Or is it a major flare of rheumatoid arthritis or lupus that warrants more aggressive treatment to calm the immune system before it does permanent tissue damage?"

At this point in medical science, it's fair to say that autoimmune diseases, like many chronic disorders, are generally treated rather than cured. New areas of research, particularly advances in gene therapies, may change what is a chronic disease and how we treat it in years to come.

In the meantime, the best advice to help patients live better with chronic disease is to help them learn why and how to take their medications as prescribed, eat healthy, be as active as they can when possible, get plenty of restful sleep, avoid stressors, and take the time to savor what they love about life.


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  Advanced Arthritis Care, chronic care, Chronic disease, Gilbert F. Douglas MD, Nop Unnoppet DO, Norwood Clinic, Shelby Baptist Medical Center


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