Thursday, May 21, 2015

What if? The best and simplest medical advice for a healthy life

What if I told you that medical care across the world could be dramatically improved by a single act that costs almost no money and has almost no risks involved? What if I told you  that this same medical act could save more lives than many recent technologies like CT scans and MRIs and advanced microscopic surgeries? I think it is fair to say that most people would demand that such a medical act be performed as often as possible.

If we could get every single physician, nurse, healthcare provider and patient to wash their hands before and after interacting with their surroundings, we would save millions of lives every year. It is truly astounding and very difficult to believe that a doctor would not hesitate to order expensive and invasive tests, but would easily forget to wash his or her hands before touching a patient. The obvious question is why?

Modern medicine has created a conundrum. We assume that all of the “simple” diseases have been conquered and that our modern technology is fighting a relatively small group of problems that are very difficult to treat. This assumption is totally incorrect. People who are lucky enough to have been born into a society that has widespread healthcare, assume  that they do not need to worry about diseases like polio and measles. One only needs to look at the newspaper to see that those who have not vaccinated themselves continue to suffer and even die from diseases that were until recently forgotten from a great part of the world.

Medical students are taught early on in their training that “common things are common” and that “when one hears hoofbeats, they should look for horses and not zebras”. The point of these statements is to remind medical students that real-life is not a TV show where semi-angelic doctors discover that a simple fever is in fact a dangerous and rare disease that will require the most advanced treatments to overcome. In real life, in the vast majority of cases, a simple fever is simple. It is not a sign of a dangerous disease. It is often secondary to a simple viral infection that will pass on its own. The role of the real-life doctor is to rule out the relatively small number of cases where a fever really is a sign of a dangerous problem.

I have personally had the honor of working in various medical services that provided me direct access to hundreds of thousands of patients over my career. And thousands of these cases,  I was the primary doctor seeing the patient. In tens of thousands of these cases, I was a consultant who was brought in to discuss the case. And in the rest of these cases, I was a reviewer of charts to provide quality assurance and follow-up for the patients when necessary. In all of that time, even living in the Middle East in a country that is in many ways a portal between the westernized world and the developing world, I never came across a case of Ebola. I have seen a few cases of malaria. I have only seen a couple of cases of Lyme disease. And I have unfortunately come across a number of cases of cancer, some of which had not yet even been diagnosed. I think it’s clear though that I have spent my medical career doing things that would not make for very good TV. Welcome to the real world.

So what can I offer a patient in this real world? What advice  can I give to people to improve their chances of staying healthy? How can I guide a patient so that he or she reduces their risk of cancer and other life-threatening diseases? I must admit that the source of my advice is not from the most recent edition of the New England Journal of Medicine. A great deal of my advice stems back to Hippocrates and Maimonides. In fact, even if they did not understand the actual pathology of the diseases they treated, they still managed to provide a very good level of care to many people.

My basic advice would unfortunately not fill the pages of a new age “better life” book [so that I could sell the book and make billions]. My basic advice is as follows:

  • Eat a reasonable diet. There are thousands of diet books and videos and interviews that all describe the best way to eat.. I can professionally say that the sum total of our knowledge in regards to diet is to eat intelligently 80 to 90% of the time, and to allow yourself to eat naughty foods the other 10 to 20% of the time. So eat your vegetables, peel an orange a few times a week, eat fish three or four times a week, have a nice piece of meat once or twice a week, drink a good amount of water and enjoy a couple of scoops of ice cream on the weekends. Based on what I know of the accepted medical literature, there is no diet that will produce better results than this one.
  • walk and lift a reasonable amount of weight, four times a week. I could’ve said three times a week or five times a week, but four seems like a good average. Notice that I did not say “run”, because as it turns out, running can cause  a lot of wear and tear on our joints and make even walking difficult as a person ages. Bicycling is fine and so is swimming.. The key is to move and especially these days, push yourself away from the screen [whether it be 54 inches or 5 inches across]. The importance of weightlifting is that it stimulates muscles across the entire body. In practice, there are really only two or three exercises that a person should do to stimulate the critical set of muscles that will preserve our straight backs and healthy pelvis throughout our lives. People who exercise tend to suffer less from falls. People who exercise tend to remain independent far longer.  Exercise may even have a protective effect against Alzheimer’s. A simple and safe exercise program is magic. And once again, I feel more than comfortable challenging anyone to show me medical literature that supports a different approach with clearly superior outcomes.

  • Sleep. It’s not that complicated. At a certain point in your day, you shut off the TV, put your phone on mute  and enjoy the comfort of your pillow. The benefits of sleep are tremendous, and we are still learning a great deal  about the importance of sleep. Nearly half the world is sleep deprived. And yes, that means that half the world is performing far less  than their best. Imagine if I told the CEO that I had a method for increasing productivity by 50% with minimal investment and zero risk to the employees. I think that most CEOs would jump at such an opportunity. Now, imagine me telling the CEO that we are going to train people how to sleep better. I can promise you that many CEOs would end the conversation at that point. But of the few CEOs who would be willing to listen, they would eventually benefit tremendously from a workforce that knows how to sleep. Eventually all of the doubting CEOs would come knocking. Good sleep is equal to a better life for the employer, employee, their families and friends and everyone around them.

  • See your doctor. 100 years ago, one of the key roles  of physicians was to teach people the basics of public health. When a person became ill with a communicable disease, it was the role the physician to identify the disease and begin to isolate the sick patients from the healthy population. Such an approach was fundamentally important to restricting the spread of deadly  infections. In this way, not much has changed. a doctor today should be teaching parents about how to raise their children in a healthy way [and this includes vaccinations]. If a child is having difficulty  in gym class, the family physician will assess the child for asthma. Asthma is not a very exciting disease but it is unfortunately very common and at times life-threatening. Identification and treatment of this disease can restore a child to a normal life. There are certain screening tests that have been shown to be of value in the medical literature. Admittedly, this literature can lead to different conclusions over the course of years to decades. When I was an early resident, the standard was to check all males of a certain age  for prostate cancer by using a special blood test. Today, the recommendation is not to use  such a blood test for screening. When patients ask in a legitimately confused way how it can be that yesterday, something was essential and today it is contraindicated, the physician has to take the time to explain how science moves forward. A physician is a purveyor of knowledge. It is the role of the physician to learn and continue to study throughout their careers in order to always be able to answer the questions that patients have. And when the physician does not have the answer, he is expected to consult. The role of the physician is to be a guide through life in order to maximize the good health of the patient no matter what maladies that patients may encounter.

Even with the best of intentions and the best of genes, people get bad diseases. And it is at this point that we are very lucky to have  advanced technologies to identify those diseases and treat them. This is also appointed which a family physician can act as an interpreter between the specialist who is deciding on the care and the patient who has to make a decision about whether to follow the specialist advice. Diseases like multiple sclerosis and diabetes and inflammatory bowel disease and rheumatoid arthritis, used to be the harbingers of a life of misery before an early death. Today,  we are far better at managing these diseases, and the hope is that we will be far better in the next decade. I personally feel that we are in the midst of a perfect storm of basic science, engineering, biology, financial investment and other components that will all finally meet in a big bang that results in cures for diseases that we once thought were incurable. When people ask me  what I pray for every day, it is to have the privilege of being alive to experience these magical moments.
To all who are reading this, I can honestly say to you that the future holds great promise and is a tremendous source of hope. Smile every day, even laugh for no good reason. The medical literature actually shown that laughing can dramatically improve a person’s health. Oh, and I almost forgot about having great sex at least three times a week. Once again, yes, there is medical literature about the tremendous benefits of emotional and physical intimacy.

I wish you all the best of health and the best of reasons to enjoy every moment in your life.

About the author: Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology. 

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