Our teenaged son never misses an opportunity to tease me when I do something he deems old-fashioned. “Hey Mom and Dad,” he’ll ask, “what was it like back in the 1900’s?”
While our son’s question is rhetorical, it did get us thinking about how much has changed in our field of study: medicine. At the start of the 1900s, the practice of medicine was based on a “symptom model” where care was sought when patients felt poorly and would see a doctor who would try to make them feel better.
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Addressing symptoms is important, but in the 21st century, many major medical problems do not present symptoms before they cause trouble. No one has ever said, “I feel I may have a stroke soon,” or “I think I may break a hip.”
So, what about age itself? Is aging symptomatic? Is aging a disease? Can aging be fixed? In cardiology, for example, there is (almost) no such thing as heart disease. It’s just natural aging.
But these are all urgent questions given our aging population. Never before in human history have there been so many people over 70 years old. The baby boomers are here and thanks to medical innovations and discoveries, they’re living well beyond the life expectancy of 63 back in 1900. And, this natural aging is contributing to the most common cause of death — heart disease.
Aging is a process, not just a bag of diseases or symptoms. In fact, aging involves many processes that have been very well studied. We understand what happens and how it happens. Many of these are very predictable, measurable and manageable – and this includes heart disease. With this understanding, we can move from a “symptom model” of care to a “process model” of care.
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We know that a heart attack is damage from a clot forming in an artery that has plaque, but we know that plaque grows as part of a natural inflammatory, or healing process. We know that everyone has 100,000 heart beats a day, which naturally causes a whole lot of wear-and-tear. We know the body heals that wear-and-tear, and thus everyone has vascular inflammation. Everyone grows plaque (eventually). It’s not a disease. It doesn’t need to produce symptoms. It is a process that is part of life itself.
In most cases, we can stop plaque growth and manage disease. Yes, there is a pill that can prevent heart attacks. The key, however, is that “prevent” is an active verb. And, when it comes to heart disease, I’m sure you’ll agree it’s better to prevent a problem than to fix something broken.
There are, in fact, a great many ways we can manage many of the natural processes of aging, but to do that, both doctors and patients need to update their attitudes. Doctors, and the health care system as a whole, need to adopt a “process model” that acknowledges that with age, things naturally change. Life is a process to be managed, not a disease to be cured. Patients need to remember that life is a participation sport, and they are as much a part of their care team as their doctor. While there is no pill for fitness, taking a pill to arrest some of the natural wear-and-tear of time can help to manage heart disease.
This is the Process model. Yes, there are diseases, and yes people have symptoms, but if you’re alive, you’re aging. The good news is this means we have an opportunity to manage the process. Our current system is broken. It only allows for the evaluation of symptoms and the treatment of disease. We need to adapt to the reality of an aging population and encourage everyone to age well.
And we should remember: it’s the 21st century, not the 1900’s. As we transition to a process model of medicine, delivering preventative care and early interventions requires the healthcare payment system to evolve with it. Doing so will not only help Americans as they age, but will save the healthcare system resources in the long run as we better manage the aging process, instead of waiting until conditions get so bad that costly treatments are unavoidable.
Let’s modernize our system and let healthcare be a process in which we anticipate the natural course of aging and change the treatment paradigm from addressing symptoms when they happen to a system encouraging healthy aging.
Photo: Malte Mueller, Getty Images
Joshua S. Yamamoto was born in Washington DC. He graduated with a degree in Physics from Princeton University, earned his M.D. form Dartmouth Medical School, and trained in Medicine at the Johns Hopkins Hospital. He completed cardiology training at the National Naval Medial Center and Georgetown University. He served in the Navy as the cardiology consultant for the U.S. Congress, and holds a faculty appointment at the Uniformed Services University. In 2005, he was deployed in Kuwait at the theater cardiologist for the ongoing wars in Iraq and Afghanistan. Upon returning home, he joined a private practice, and helped to cofound the Foxhall Foundation, the non-profit dedicated to “Helping Everyone Age Well.” He is the author of two books, including “You Can Prevent a Stroke.”
Kristin Thomas is a Michigan native, who graduated with a degree in American history from the University of Michigan, and subsequently earned her medical degree there as well. She trained in medicine at the Johns Hopkins Hospital. She became the very first Hospitalist for Johns Hopkins, and was subsequently named Assistant Chief of Service (Chief Resident). She left Hopkins to pursue private practice in Washington, D.C. She was the principal creator of the Foxhall Foundation. She has been consistently recognized as one of Washington, D.C.’s top doctors, with an international reputation for her clinical acumen and dedication to her patients. She co-authored the book, “You Can Prevent a Stroke.”
