The Lucky Years: How to Thrive in the Brave New World of Health (12 page)

Most of us ignore the health care system in America until we have a problem with it, be it fighting a claim, dealing with poor service, or addressing a misdiagnosis. The passage of the Affordable Care Act left
many wondering just how much it would improve the system and at the same time lower costs. The law is supposed to “put consumers back in charge of their health care,” but I know that many don’t feel this has been realized yet, at least not in the way they imagined when the law was being initially discussed and drafted. The problem is that unless we as individuals help change the system, we won’t see a vast improvement in our system.

I’m not here to dissect the Affordable Care Act or offer advice on which plan to choose. What I do want to do, however, is show you how to participate in the system like never before so you can rest assured that your doctor’s visit a decade from now will be what it should be. Clearly, we all want the system to be characterized not only by cost-effectiveness, but also by the ability to prolong and improve the quality of our lives. And to achieve this goal, we need to take charge of the system today.

Now, that may seem like an incredibly lofty, possibly even unrealistic goal. How do we assume responsibility for the system? How do we improve something that seems so complicated, amorphous, and unyielding? Well, let me start by presenting what a future doctor’s visit should look like, as this will help you prepare and, in turn, begin to help you choose how you age.

He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.

—Sir William Osler

A
nyone who has gone through medical school or read up on the history of medicine has come across the name Sir William Osler. Fondly known as the father of modern medicine (second only to Hippocrates), Osler was one of the four founding professors of Johns Hopkins Hospital who revolutionized the teaching of medicine. When he arrived at Hopkins in 1888 as physician in chief, he was already a well-known doctor and somewhat famous clinical teacher. Among his most endearing lessons was his use of alliteration to help his students retain information. The “Four F’s,” for example, could result in typhoid fever: fingers, food, flies, and filth. His landmark textbook about internal medicine,
The Principles and Practice of Medicine
, was published in 1892 and remains continually updated to this day.

A photo of Sir William Osler writing his textbook,
The Principles and Practice of Medicine,
in the room of his chief resident, Hunter Robb, in the Billings Building at the Johns Hopkins Hospital. Osler had asked to “borrow” the room for an hour from Dr. Robb to write his masterpiece, but ended up taking over the room completely for six months.

Short and wiry, with a handlebar mustache to boot, he always dressed in three-piece suits topped with a silk bowtie. And Osler was as much renowned for his practical jokes as he was for his doctoring and teaching. In fact, “Osleriana”—language from his written works—still appears frequently in the
Journal of the American Medical Association
, as a reminder of his wise and common tidbits.

Perhaps Osler’s greatest contribution to medicine and to health care in general was to require that students learn by example—from seeing and talking to real patients. He established the first medical residency program, an idea that would eventually spread across the Western world and become the main system by which teaching hospitals operate. Even today, when you walk into a teaching hospital, much of the medical staff is composed of doctors in training. Osler also initiated another tradition in medical school by getting his students to the bedside early in their training. Rather than spend the majority of their time sitting in a lecture taking notes, third-year students mastered how to take patient histories, perform physicals, and order lab tests to examine various
bodily fluids. He once said he hoped that his tombstone would read only, “He brought medical students into the wards for bedside teaching.” (Osler’s body was cremated; his ashes rest in the Osler Library of Medicine at McGill University, his alma mater.)

A caricature of William Osler that shows him elevated to a holy status as he sweeps away disease. The title,
The Saint—Johns Hopkins Hospital
, is a play on Osler’s frequent reference to the hospital as “the St. Johns.” The caricature was done in 1896 by Max Broedel, a renowned medical illustrator.

When I think back to my own medical training, I can’t imagine what my education would have been like had I not had the opportunity to learn by hands-on experience with my mentors and their patients at the bedside. It’s the kind of education you just can’t get from listening to a lecture in an auditorium, even with the best visuals or wheeling in a mock patient. After completing my medical degree at the University of Pennsylvania, I went on to the Osler Medical Housestaff Training Program, as it’s called, at Johns Hopkins Hospital. I remember the experience so well. On my first day, I was handed several pairs of white
polyester pants. These would be part of my uniform, along with the quintessential short white coat of the first-year resident. The polyester made sure that bodily fluids would roll right off. My pockets were packed with the essentials: a cheat sheet on antibiotic dosing, a quick guide to all medical diseases, a stethoscope, a reflex hammer, no fewer than five pens, a code pager, and another pager that snapped to my belt. Walking the halls in my regalia, I felt a little like Rambo. I also carried stacks of notecards that kept track of certain patients and kept me on my toes for when I’d be quizzed by one of the senior doctors.

My Osler medicine residency team at Johns Hopkins Hospital in Baltimore in 1992, my first year practicing medicine. I am in the second row, far right.

Every Friday at 8:00 a.m. sharp, we medical students sat row by row in the famous Hurd Hall. The most senior physicians sat with pride in the first row. We male medical interns wore our blue Osler ties with the word
Aequanimitas
written on them. The women wore their
Osler scarves emblazoned with the same word. It was the Osler motto. The term means “imperturbability,” a quality Osler felt was of utmost importance for a good physician. In his essay addressed to graduating students of the University of Pennsylvania in 1889, “Aequanimitas,” Osler further defined this concept as “coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril.” At these weekly events, a patient would be presented onstage, examined, and questioned briefly in front of the whole audience. Questions would rain down from the audience, and lab results would be revealed. Then a physician would give a well-studied and rehearsed lecture on the disease in question.

The power of Osler’s teaching philosophy was that it brought context to his medical students. He yanked students from the confines of their two-dimensional books of information and pushed them to see the narrative in the real, three-dimensional world of working with patients, listening to their stories, watching their illnesses, and following their treatments. He changed not only how they were learning, but also
what
they were learning.

Now, why am I telling you all this history about someone who has nothing to do with your health in the future? Because there’s a lot we all can learn from Osler, whether we’re doctors or dancers. Nothing can replace the impact of what we see, hear, feel, smell, touch, and perceive in the tactile world of communicating with living people. Just think of the difference between reading a book about how to drive a car and actually driving one, or listening to someone telling you about the taste of a decadent chocolate cake and actually tasting one. Indeed, reading and lecturing provide knowledge, but they often lack valuable context to make those lessons come to life and be truly useful.

Which is why defining your own personal context in your microcosmic world will help you reap the benefits of modern technology and live better. Bring a little bit of Oslerian mentality to your personal health care. Now let me tell you what that looks like, starting with a basic lesson in context.

What’s the best diet? Is gluten that bad for you? Are probiotics helpful? Are mammograms and colonoscopies necessary by a certain age, no matter what? Do you really have to be taking a baby aspirin daily for the rest of your life? What blood mercury level is safe? What kind of exercise will melt away your belly fat? Do plastics and cell phones cause cancer? When is the ideal time for you to go to bed so you wake up feeling vibrant?

Answer: It depends.

In the summer of 2014, I had the opportunity to travel with my family on safari in Africa. It was an amazing, unforgettable experience. A dream trip of mine. It taught me so much about this beautiful part of the world and its disparate cultures, but it also taught me a lot about myself and where I’d gone wrong in my thinking. In the past, I’ve talked a lot about the importance of using the best scientific data to know what you should be doing daily to live longer. Two of my biggest recommendations for people over forty, which have become points of contention for many opponents in debates with me, are taking a daily baby aspirin and considering the use of statins.

This latter suggestion is the one that caused the most stir, and it continues to get me into trouble with people who think statins are a poison to the body. Indeed, they can have unpleasant side effects in some individuals, which is precisely why they aren’t for everyone. But a truth remains: multiple high-profile and rigorously controlled large studies have shown that their use can dramatically reduce the incidence of heart attack and stroke and, due to their powerful effects lowering inflammation in the body, they reduce total mortality.

Contrary to popular wisdom, statins are well tolerated in people who are the ideal candidates to take them. And most of the criticisms against statins are based solely on a philosophical aversion to them. But today I admit that I could be okay with their philosophies to some degree. Why? For starters, let me share what my African guide told me when
I asked him about how he protects himself against malaria, an illness that’s endemic to his environment. What he said to me got me thinking differently: “I don’t take antimalarial pills because I don’t want to take them indefinitely.”

Malaria is a rare but life-threatening blood disease caused by a parasite that is transmitted to humans by the
Anopheles
mosquito. It’s preventable and curable but continues to plague many parts of the world. Most malaria cases and deaths take place in sub-Saharan Africa, but Latin America, Asia, and, to a lesser extent, the Middle East and parts of Europe are also affected. In 2014, ninety-seven countries and territories had ongoing malaria transmission. The complexity of the malaria parasite has evaded efforts to make a vaccine against it, though many have been in development and ones that have shown the most promise offer only partial protection that declines over time.