As African American orthopedic surgeons operating in the US health system, we have spent our entire careers helping people get back “in the game” after bone and joint injury or disease that resulted in immobility and disability. We have taken all comers and have always done the best we could to be of service to all. However, it is recognized that in our healthcare system, African Americans, ethnic minorities and women have historically experienced poorer outcomes in a number of disease categories and in care of their musculoskeletal health. Factors identified for these differences, called disparities, include poor general health, a sedentary lifestyle, poor nutrition, obesity, untreated depression and poverty. Implicit and explicit biases also exist among healthcare providers and patients, both of which contribute to these disparities.
We want to emphasize the fact that there is every opportunity to change this reality for patients who commit to a healthy lifestyle by maintaining a consistent level of activity. Undeniably, there are inherent challenges in any effort to provide equitable healthcare for everyone in America, but we believe our nation’s health resources are sufficient to achieve such a goal, if there is strong will and determination on the part of patients and potential patients.
Each of us must do our part to start from as healthy a place as possible. As physicians, we have come to recognize that how patients approach their health can be a gateway or a barrier to their access to orthopedic care. We regularly remind patients that they absolutely must take personal responsibility for the health of their bodies because how they manage their health will affect the way they are perceived when they present for medical care. Patients who present with knowledge and action around healthy habits–from what you eat to how you do, or do not use your body–matters, because it impacts how well you will respond to treatment.
Physicians admire and are motivated to be part of the health team for a patient who is working proactively to avoid the ravages of chronic disease. Nutrition and exercise are critical to controlling the effects of chronic afflictions such as obesity, heart disease, diabetes, hypertension, and even the pain of arthritis. One key indicator of health is a patient’s activity level, so if a patient is committed to being mobile, she will have a distinct health advantage over her sedentary counterparts.
Pain is the main complaint that brings the aging patient to the orthopedic specialist. Arthritis, in its various forms, is usually the culprit. It is a significant challenge for caregivers to alleviate arthritis pain when a patient continues to lead a sedentary, inactive lifestyle. These folks tend to be obese, deconditioned, and they are likely to suffer more disability from their pain. These factors make it more difficult for any treatment offered to be successful.
If you see yourself in this picture, you must become the prime actor in your healthcare. Refusal to be disciplined about staying active and maintaining a reasonable weight places you at a disadvantage when you seek care within the health system. Let’s be clear, an obese, sedentary patient is not the patient hospitals or doctors are seeking to take care of. Historically, doctors have put themselves on the line for their patients. Many will continue to do so. But it is important for you to understand that under the new compensation formulas, doctors and hospitals will be penalized for patients’ poor outcomes. Because patients with multi-systemic health conditions are at higher risk of poor outcomes, medical professionals have a disincentive to offer state of the art treatment to the person who presents as someone who can’t be bothered to seriously attend to their own health.
In an ideal world, doctors and patients are on the same team, working toward a commonly held goal of good health. The mutual admiration and respect that characterizes a healthy patient-doctor relationship is put at risk when one party suffers because the other has shirked their responsibility to the healthcare enterprise.
No matter what our new government does, either improving the ACA (Obamacare), or repealing it and imposing the AHCA (Trumpcare), the fundamental relationship between a concerned physician and a motivated, cooperative patient remains the basic building block to achieving optimum health outcomes.
Bringing your most healthy self to any medical encounter returns a critically important measure of control to your wellbeing.
We’d like to leave you with our enthusiastic best wishes and what we think of as the ten of most profound 2-letter words ever put together:
“If it is to be, it is up to me.”