VIRGINIANS OF INTEREST
Carthan and Brian have been friends for more than 30 years and share a passion for all things Virginia! They lost touch for many years, but reconnected in 2020 while Carthan was involved with the Economic Development Office for the City of Petersburg and Brian was working on the Medicines for All Project at Virginia Commonwealth University. Both talked frequently about various issues facing the Commonwealth and started kicking around the idea of a podcast. Both Carthan and Brian consider themselves a bit technically challenged, so when the opportunity to host a podcast at Blue Ridge PBS in Roanoke presented itself, they jumped in with both feet!
We hope you enjoy the conversations!
VIRGINIANS OF INTEREST
E38: Healing at Home: Dr. Lisbeth's Patient-Centered Approach
And now from the Blue Ridge PBS studios in Roanoke, virginia. It's the Virginians of Interest podcast, with your hosts Brian Campbell and Karthin Curran.
Speaker 1:Hello and welcome to the Virginians of Interest podcast. My name is Brian Campbell. My friend Karthin Curran cannot be with us today. Our guest today is Dr Priyanka Lisbeth, who works for a company called Harmony Cares and practices a unique type of medicine. She makes house calls and we're really happy to have her today and look forward to talking with her about emerging practices in medicine and a little bit about what her life is like as a physician that makes house calls. Welcome, dr Lis.
Speaker 3:Thank you so much for having me, and I'm very excited about this opportunity.
Speaker 1:Great. Well, before we get started today, I want to understand. I know a little bit about you. Tell me a little bit about growing up and where you went to school and all your medical training and so forth, and how you ended up where you are today and the practice that you lead how you ended up where you are today and the practice that you lead.
Speaker 3:Yeah, so I had an eventful childhood. I grew up in India and I moved here when I was a teenager, which is not the best time to switch countries, but we did, and I have been a Virginian ever since, so I call myself a proud Virginian. I started going to school in Blacksburg and then moved to Stafford, Virginia, then went to engineering school at VCU, which is where I met Dr Gupton, and after that I started working as a chemical engineer, realized it wasn't my calling so decided to go back to school for medicine. I went to Edward Villa College of Osteopathic Medicine in Virginia Virginia Tech area. So I went back to Blacksburg again and then came back to Richmond for my residency at Bon Secours in family medicine.
Speaker 3:So I spent three years at St Francis Hospital here in Richmond and then after that went to VCU for a geriatrics fellowship. So I spent half of my time at VCU and the other half at the VA Meguiar's, and that's really where I fell in love with House Calls. After that I started working, actually took a job at the VA and worked there for about a year and a half and decided that I truly am somebody that is meant to see patients at home, so ended up starting to work with Harmony Cares, which is where I am now.
Speaker 1:Well, great. So tell us a little bit about that evolution. Was it one patient or in particular that just sort of made this click? Or was it just the idea that people seem to respond better to you when they're more comfortable in a home setting?
Speaker 3:Yeah, I think I realized pretty early on that when a patient is coming to you in the clinic, that is their best. You know that is them having put themselves together and gotten dressed and you know if they required support getting to the appointment and they are there showing their best self. You know you don't really find out if they're. Are they truly taking their medications at home? You know how are they walking at home, how are they getting around.
Speaker 3:I felt like it gave me an incomplete picture to work with, but when I, you know, when I was at VCU and the VA and started seeing patients at home, it really clicked for me that I was truly able to get to know them on a deeper level and help them on a deeper level with things that matter to us at the end of the day, which is our mobility, our mood, making sure we're actually taking the medications that the doctors prescribe, which can truly be very complicated. I help patients make their pillboxes and I'm realizing actually how complex it is if you need to take 10 meds a day. So I think of it as selfish. It truly to me feels like the best kind of care you can provide to someone and I'm lucky I get to do that.
Speaker 1:Well, we're going to zoom back in to you shortly, but let's zoom out for a little bit. It's funny when I've shared with people that we're going to have this podcast with you, a lot of people are sort of shocked because you know particularly people that are even older, who once knew people when doctors made house calls, which was a long time ago, and when they hear that it's happening again, they just sort of they fall out of their chair and go what do you mean? Doctors are making house calls again. It's as if somebody has landed on the moon. Why is it that our country, or your company in particular, and why do you think medicine in general, needs to revisit the idea of this patient encounter and where it occurs?
Speaker 3:Yeah, that's a great question. So our company is a value-based company I'm not sure if you're familiar with value-based versus fee-for-service and we can go into those models more, those models more. But what we see as a company are the biggest challenges right now in healthcare are access to care, affordability to care and equity, and we are really able to focus on these aspects and actually provide the care that our aging population needs care that our aging population needs. So, according to the Department of Health and Human Services, by 2040, one in five American is going to be over the age of 65. That is huge. That means 20% of the people around us are going to be over the age of 65. So basically, by 2030, all baby boomers are going to reach above 65. The support, the infrastructure for such an aging population is just not in place.
Speaker 3:So companies like ours, and especially the value-based care model, is realizing that we need to kind of reel back medicine the way it is currently and take a look at, you know, what really works for the patient, what the patient really, what really matters to the patients. Because one of the things we notice is just in medicine right now, it's just all about doing more and more and more. But what about what the patient truly wants and what their wishes are? But what about what the patient truly wants and what their wishes are? So our model really focuses on better patient outcomes, cost effectiveness and just a better healthcare experience overall, which starts with when you provide that care at home. You know it takes out having to go to the doctor's office, I think. You know.
Speaker 3:I think one of the things we, when we think of a patient that is elderly going to the doctor's office, it is a very complicated procedure. You know they have to get ready. They have to. You know, if they have mobility issues, they have to get either a walker, then they have to walk with their walker, find parking. Walk with their walker inside, you know, could be a really long walk depending on where you find parking. Sit in a waiting room for hours. Patients are on diuretics or fluid pills. You know which is a fluid pill that they have to take. That is a lot for these patients. So I think I'm kind of going into the nuances of it. But this is great.
Speaker 3:Companies like Harmony Cares. We take away the you know that whole process of getting to a doctor. Now I imagine if you have to do this, you know, every month, or some people actually have to do it every couple of weeks because they're so sick so we're able to get to them, we're able to make sure they're taking their medications, we're able to really spend quality time with them. So you know, our visits are 30 minutes and, depending on what we're doing, it can be even 45 minutes to an hour that we're able to spend with these patients.
Speaker 1:Well, you know, as you were describing this about 20 years ago, I lived in Iowa when this was when fiber optic was being laid out and the winters in Iowa are just awful and they were trying to get fiber optic to rural areas specifically so old people could do telehealth right, so they wouldn't break a hip because they would fall on the ice going to the doctor. But then, as you were describing this, I said isn't there certain limitations to telehealth though? So I mean, telehealth means you don't have to leave your house, but the physician isn't in the home witnessing everything in the home, correct?
Speaker 3:Yes, it's such a great question because they're, first of all, most of my patients. They just the idea of getting on telehealth is just not that easy. It is not. You know, most of my patients that are, you know, I see from anywhere. You actually see patients that are, you know, in their 20s as well, and we can go into that. But anywhere from 20s to my oldest patient is 100 years old.
Speaker 3:It is very hard for them to figure out how to either have a smartphone, get on a telehealth link and some of them do, you know, it's not all of them, but most of them. It is just a very complicated process. A lot of people actually don't have smartphones at that age or they have trouble looking. You know, they have vision impairments. The other thing you mentioned is a true exam. So I'm not able to actually take a look at their legs or take a look at their wounds. If I'm over a telehealth visit, it is, you know, sometimes you can, but it's very limited. I like to call myself nosy, you know I want to get in there and I want to look at their meds, I want to look at their wounds, I want to see how they're walking. So this job really gives me the opportunity to be able to do that.
Speaker 1:Well, let's stay at 30,000 feet for a little bit too, and discuss medicine in general, health care in general, and I was mentioning, I think, to you yesterday. I was listening to a podcast recently about a new company that's trying to help people of middle and lower class simply access care. So, in other words, now you know, for whatever reason, you find yourself chronically ill or you've been discharged, maybe you've been relatively healthy your whole life, and then suddenly you have a chronic illness and you go to the emergency room and you're in the hospital and you finally get discharged, but now you're going to need more follow-up care and then suddenly you need to access providers that you didn't do before and that's really complicated. So how has that occurred in our country historically, how is it occurring now and how do you think it will occur in the future?
Speaker 3:Yeah, I think we are a very specialist-driven country. So you know, everybody wants to see a specialist for whatever that comorbidity is and there just aren't enough specialists. We have a growing aging population and for them to be able to see these specialists and to get that care, get to those appointments, it is very difficult. One of the things we are moving towards is providing as much of that care at home. So you know, I'm not a cardiologist, I cannot perform a CAT, or I'm not a GI doctor no-transcript that lives alone to pick up the phone and make that appointment with that specialist and get to them being on the phone and making that appointment, getting a time that works for them. I have so many patients that live alone, that don't drive, that don't have the transportation to make it to these appointments, so there are so many factors that play into this, which is where companies like ours have a whole team where we can sit down and we can work on okay.
Speaker 3:So Mrs Johnson needs to see a cardiologist. She is having, you know, anginal pain at a regular basis. She likely needs a cat. We're able to make her that appointment. We're able to look at the transportation options and see how we can schedule that, whether that's through Medicaid, if she's eligible for it, and that's a whole another. You know we can go down the rabbit hole of even just getting Medicaid is a very hard process for our sick patients. You know for them to call and put in all that information that's needed for them to qualify is a really long process, but I think I'm digressing.
Speaker 1:Them to qualify is a really long process, but I think I'm digressing. No, this is great. I think part of it is helping people understand. You know, everybody looks at the American healthcare system and I don't think anybody looks at it and says, gee, this is a really terrific system and functions well. I think part of it is that the discussion we're having now is helping people understand its pros and cons. So keep going, You're doing great.
Speaker 3:It's pros and cons, so keep going. You're doing great. Yeah, I think we have the best specialist in this country. I truly do. I love my co-workers and my specialists. You know my dad has had a lot of medical issues and I say the reason why he's around right now is because of these specialists. He's had a lot of eye complications, he sees a retinal specialist, he sees a cardiologist, he sees a neurologist.
Speaker 3:But just the access to these, just getting to these appointments, is a very complicated process is how much does the patient really want to do? One of the things we don't do as much in medicine is asking a patient what matters to you. You know what truly matters to this patient. Is it their mobility, is it their vision? You know, because they're an avid reader or they're a gardener and they want to focus on being able to be in their garden as much as they can.
Speaker 3:So going back to that quality of life and what is important to you is where we begin, and then we try to put those pieces together. Whether it is seeing a specialist, how do we actually make that appointment and get there? Something I do very commonly is just get on the phone with the office and make those appointments for my patients Because it is, you know, it is very easy for me to use the physician line and advocate for them, versus one of my patients sitting on the phone for 30 to 45 minutes. That is hard of hearing, so, yeah, so I'm lucky that I get to advocate for these patients.
Speaker 1:You're doing such a great job of explaining things. It reminded me of two quick stories that I'll tell. That, I think, will help our listeners also understand the current state of affairs in medicine. I used to work for a medical school dean and I'll say his name. I'll send him the podcast to make sure he listens to it Bob D'Alessandri.
Speaker 1:He was a long serving dean at West Virginia and I worked for him up in Scranton, pennsylvania, and he was not only a great physician but he was one of the best storytellers I'd ever met, and we would go out on the road and mainly trying to raise money, but he would tell these great medical stories and one of the ones that he told as a young physician was he had a patient with hypertension and he used to joke and he said so I put her in the hospital. He said that was back when you could put a patient in the hospital for hypertension and what he said was that she wasn't compliant with her meds and he said that was one way you used to be able to tell whether a patient was compliant or not was literally stick them in the hospital and monitor them. So that was something we don't do anymore. But the other thing that I want you to respond to. The story that he told, which this, to me, encapsulates the entire problem with our system, was, he said, prior to I guess it was when Medicare and Medicaid the whole idea of coding right? He said we used to have relationships with our patients. Now we get paid to do things to people, meaning everything in medicine now revolves around this idea of a code meaning whatever.
Speaker 1:Every time I go to the doctor, you go to the doctor, there's a code related to something that the physician or the provider has done to the patient. And I thought that was the whole ballgame right there when he described that to me. That to me, related to why the system has its flaws right, that at the end of the day, it's about the procedure and then it's about the reimbursement. Was that a correct storytelling? On behalf of the great Dr Delisandri? Dr Delisandri.
Speaker 3:Yeah, I love both of those stories. So I want to go back to the first one, with the hypertensive patient not taking her meds. Yeah, at this point she would be discharged from the emergency room because of our healthcare system just doesn't have the you know, we having renal failure from it or neurological symptoms, that's different, but you know, not taking them. I want to talk about not taking medications and then we can talk about the coding part of things. But one of the things that I have learned in this job is taking medications is very. It is not an easy process when somebody is on, let's say you know, 10 to 12 medications a day. Some of them are twice a day, some of them are three times a day. One of them needs to be taken in the morning before eating anything like Synthroid or Protonix. It is a process. So I have started helping patients make their pill boxes, where I, you know, I try to ask my office manager, lynn, for a one-hour visit so I can go and make their their actual pill boxes and my nurse and I will be sitting there and we actually get confused. We have to really pay attention to what we're doing putting putting those pillboxes in the right containers and then making sure that all 12 or 15 of those meds, whether it's twice a day or three times a day, are in there. And to expect our patients to do this, our elderly patients to do this, it is just not an easy task. So I really don't like the term non-compliance anymore, because I realized it's usually not because they don't want to, it's because there's so many additional layers there.
Speaker 3:I have this one patient that comes to mind. He's on warfarin or Coumadin, which you know, which is because he has a heart valve replacement. So this medicine, if it is not taken the right way, if you take too much of it, it will lead to INR elevation. You can have bleeding from it, essentially if you take too much Coumadin because it's a blood thinner. So he's had multiple hospitalizations because he was taking his Coumadin. He was taking too much of the Coumadin.
Speaker 3:Because of his visual impairment, he is almost blind. He's not able to see what he's doing. He really has a hard time looking at the pill bottles and actually realizing which one is Coumadin and which one is this one or that one. He's on about 12 to 15 medicines, so multiple hospitalizations for having significant GI bleed, which can be you know that can be deathly. He's been lucky that he has made it so far. Now we're seeing him and we actually were able to get him prescription glasses through. We have a fund where we can get patients certain things you know that they absolutely need but are not able to afford. So that has helped his vision somewhat. I also go and make his pillboxes for him. You know I feel lucky that I'm able to do that for him and we've been. We're hanging on where you know we have prevented hospitalizations and he's a happy camper. So and he's very, and he's so, grateful for this. So it's again. I just I keep on going back to being grateful for what I do.
Speaker 1:Wait, did you want to talk about the coding right?
Speaker 3:Yeah, I do want to talk about the coding. I wanted to see if yeah, so you want to talk about the coding, right? Yeah, I do want to talk about the coding. I wanted to see if yeah, so I want to talk about it. I think this will be a good segue to value based versus fee for service models. Are you familiar with those models?
Speaker 1:I am, yeah, I am.
Speaker 3:So the fee-for-service model is kind of what you referred to the coding part of things where the more you do, the more you code, the more you're paid for. And that's kind of how our society, our medical society in America, has been based, where it's a volume-based model. So the more labs you get, the more office visits you have, the more a provider is reimbursed. So the more codes you put in, the more essentially you know their reimbursement is based on that. But the future of medicine that personally I think is more value-based. It's focused on outcomes. So at my company, like I was telling you, we're a value-based company. What we're focusing on are actual patient outcomes and that is how we are reimbursed. So I can go into a simple example. Let's say we have a patient with diabetes. In a fee-for-service model, the physician or the healthcare institute will be reimbursed based on how many visits this diabetic patient has. So they're coming in, they're seeing the provider, they get a certain fee for the visit. It doesn't matter what their A1C is, what their A1C is. So you know their A1C could be 10, but as long as they're coming in for these visits and that's what leads to the reimbursement. While a value-based model, you get paid based on what that A1C is actually doing. So if we're actually able to get that number under goal or in goal, that is what we're aiming for, so it can be A1C.
Speaker 3:It can be getting a breast cancer screening, getting colon cancer screening. We know those. You know cancer screenings are. It's a huge way, you know it's shown, to prevent cancers. Colon and breast cancer are very well known screenings that can be done early on to detect cancer and prevent. So that's a little bit of a difference. That's kind of where I think our medicine is going and should be going, going back to really what matters to the patient and the patient outcomes and cost effectiveness.
Speaker 1:Well, it's funny you mention that, because back when I worked for Dr Bob this was about 20 years ago when the electronic medical records were finally becoming ubiquitous and I watched a video about the British Health Service where you know you have a physician that manages your care, and they said then they finally had the data, so they were reimbursing physicians in the British Health Service for exactly the way you described it. So, in other words, once you finally had the ability to capture the data, you were paying physicians based on health outcomes, no longer on, as Dr Bobby used to say, for doing things to your patient right. So that was a terrific job of explaining all that. Thank you very much. Let's get back to you a little bit. So at some point you took additional training in geriatrics. What caused that light bulb to go off?
Speaker 3:That's a great question. I think I've been intrigued by the aging process very early on in life. I think I've just always been an old soul, so it was somewhat natural to me. I told my friends in med school that I was going to be a geriatrician, so it's something I just kind of innately maybe, knew. You know, I lost my mom when I was really young, and so that is something I have thought about at a very young age and it's something that I have felt, I guess I felt comfortable with from a very young age.
Speaker 3:I've realized, you know, I tell my patients this all the time I say nobody makes it out alive, none of us are going to make it out of here alive. That's just the. You know, that's the cycle of life. So and then the you know, what I saw early on in medicine is aging in America is something that is not discussed. There's inadequate planning, there's inadequate support for our older adults. It's a very complex issue and there needs to be a lot of different layers put in place, especially as the baby boomers continue to age. So I was just, you know, truly just attracted to the aging process and I think there are so many fields in medicine that are attractive, but I guess to me it was always geriatrics.
Speaker 1:And did you make that decision while you were still in your other residency and you just decided to do some subspecialty work? Was that when the decision was made?
Speaker 3:I think when I did my training in family medicine at Bon Secours it was during COVID and I truly feel like the training during COVID the residents, the med students we did not get that well of a training. You know, I honestly didn't feel as equipped to start going out in the world and seeing patients and I felt like I needed more training back then. So my third year of residency was essentially telemedicine. It was me just doing, you know, because I was a third year resident, I was allowed to do telemedicine visits at home. So I would just sit at home and do these visits and I truly felt like my training was, you know, it was affected by COVID and, again, just my passion for geriatrics, the two combined. I knew I wanted to learn more and do better for my patients. So I decided to do that extra year of training, which is when I went to VCU and the VA, and it was honestly it was the best decision I've made because I felt like I had so much growth and learning in that one year.
Speaker 1:Well, this is a little bit of a sidebar to that, but isn't there? There's a lot of discussion in our country about people making decisions on how they're going to practice based on debt and medical student debt and so forth. So, and I presume when you make a decision to go into geriatrics, it's like a lot of other sort of primary care you're not doing it because you're going to get rich doing it, right.
Speaker 3:Yes, yeah, that is funny that you mentioned that. Yes, you're. You know if going into medicine you can. You know if you study hard enough, work hard enough, you can become a specialist, a subspecialist and be making a lot more money than a primary care physician. I think, personally, anybody in medicine, whether it's a nurse, a physician, you know it's a physical therapist, occupational therapist. It is emotionally a very grueling career and you cannot do it just for the money. So if you are doing medicine because you just want to make a lot of money, I think you're always going to be miserable. You know it is. At some point you need to start feeling that it is a meaningful job to you and if your job does not feel meaningful, like any job, you are not going to give your patients the best care. You know you are going to feel the burnout in medicine because you're constantly seeing these really sad stories, really sad stories, the patient's lives that you know you're taking home. I actually have something I wrote I can share with you about this whenever we have an opportunity.
Speaker 1:Let's do it now. Let's do it now.
Speaker 3:Yeah, all right, so I have started writing a little bit. I call this story the Big Love and it kind of explains you know why you have to love what you do in medicine. All right, so here it goes. I get to witness that forever kind of love. I get to witness the in sickness and in health love, with emphasis on the sickness. I not only get to be part of the most intimate and vulnerable moments in a person's life but also assist them in making decisions that align with what truly matters most to them.
Speaker 3:I am a house call physician. Recently I witnessed the deepest sadness in a husband's eye as he realized that the one-sided effusion that his wife was experiencing is likely from the cancer which was previously in remission but now progressing. They are high school sweethearts from New York who complete each other's sentences with such grace that the conversation always flows beautifully. I've had multiple encounters now with them, bantering and completing each other's thoughts, but on this particular day they were both quiet and there were no sentences in need of completion.
Speaker 3:I've now also spent countless encounters with another patient of mine crying out loud in agony as his wife is passing away at a long-term care facility.
Speaker 3:He cries because not only could he not take care of her due to his own medical health, which led to her having to go to a long-term care facility, but he's also unable to visit her during her last days outside as she would require special transportation, as this would require special transportation which he cannot afford. I have many friends and family tell me that my work has to be challenging for me emotionally. What has helped me carry on is that in these moments of pain and suffering, I see their deep, big love, the love that is better than what we read about in the story tales. The love that is built on over 50 to 60 years of working through this magical thing we call life, built on over 50 to 60 years of working through this magical thing we call life, the love that stayed together when the going got hard. With every such encounter, I take away how lucky I am to do this work and call myself a house call physician.
Speaker 1:Wow, I don't really know where to go from there. That's beautiful. As you were reading that, I was thinking back when I did work at a medical school and thinking that there was a problem about 20 years ago with medical students showing up with empathy and leaving with less empathy. And it seems like to me I don't know, I don't know, it seems I don't know you that well, but it seems like you didn't have that problem. It sounds like you're you left with as much empathy as you came with, and it sounds like you still have a lot of empathy that you practice with, and that's just lovely. I don't know what else to say other than it sounds like to me your patients are lucky to have you.
Speaker 3:Oh, thank you. That's really sweet, I you know I was telling you I think of it as selfish, I think, to get to be able to do something you love every day. And you know I'm not going to sugarcoat it. I have my bad days, I have days where I feel defeated, but I have a really good team to cheer me on. You know I have a lot of good people around me at my job. When the days are hard and I think this is me going back to you know, if you go into medicine for the wrong reasons, it is really hard to just keep going down that road. You know we know about physician burnout. We know the suicide rate is highest in physicians. So it is truly important to find your purpose in the medical field because it is a very emotionally grueling career.
Speaker 1:Well, I'll say one last thing about your story there, and then we can move on to another question, and that is I think maybe they should integrate your story into medical school curriculum, just to make sure that people understand what the great purpose is. Tell me what a typical day for you looks like. You make house calls, so you get to work, and you get in your car and you go see patients. Tell me about what a typical day looks like for you.
Speaker 3:Yeah, okay, so well, I'll just start from the very beginning. I am trying to become a morning person. I've always been a night owl, but I'm trying to wake up and you know, practice what I preach. So some days I'd make it to the YMCA by 5.30 and other days I don't, which is okay. I get home by 6am. I have two little girls, two and three years old. We get them ready and I like to drop them off. I drop them off around 7, 10 and then head to work.
Speaker 3:Our life is pretty structured, if you can't tell already, and I usually like to start my day around eight. So the sooner I get in the car I have a clinical partner that goes with me. So I'm very lucky that I don't have to drive myself and I get to work on my computer while she's driving me, which is something I've. You know I didn't think I could do it because I always had really bad motion sickness, but now I'm a pro. You know she'll be going over bumps and I'll just keep typing. You know she'll be going over bumps and I'll just keep typing.
Speaker 3:So we head out around 8 am and we see anywhere from six to nine patients. We see patients all over the Richmond area, but then we also go to rural areas such as Tappahannock, we go somewhere past Petersburg, we also go up to Fredericksburg. So you know the day is definitely very busy. We, you know, a lot of times we don't, we definitely don't take lunch breaks, we kind of just eat on the go. If we have to go to the bathroom, we ask our nice patients, just because it saves us time and we can stay on schedule. It saves us time and we can stay on schedule. And then we're usually back somewhere around 4, back for the day, and then I finish up documentation and I try to head home to my girls and my husband, usually around 5 o'clock. So when you talk about the typing, that's what the business is known as charting right, exactly, yep.
Speaker 1:The charting, the fun charting, yeah, so all the fun stuff that you get incurred with the patient encounter. You're typing as you're moving on to the next appointment.
Speaker 3:Exactly and what I get to do. I get to see about six to nine patients, which is another part of the value-based model where it's more quality over quantity. So in a typical office setting, our physicians are seeing anywhere from 20 to 30 patients, which is significant to be able to chart and document and actually provide care for them. That is quality care. That is very difficult, so I'm grateful that I get to focus on more the quality of the care versus the quantity.
Speaker 1:And what type of patients? If I'm reading this correctly, they tend to be a little bit more chronically ill patients or patients that are at risk for either re-hospitalization or other types of things. Is that the typical patient, you see?
Speaker 3:the typical patient you see. Yeah, so you know. I think a lot of people think that the patients I see are mostly, you know, they are mostly bed bound, which is true, but we also have a large variety of patients, so I can see anywhere from. You know, a 25 year old that was in a you know, a car accident.
Speaker 3:It is now paraplegic. Or or a patient that had a gunshot wound when they were younger and are now homebound but they're still in their 30s. I see patients that are morbidly obese. If you're 600 to 700 pounds and you're bedbound it is not easy to make it to a doctor, but you need those services. So we have patients like that. We have patients with dementia Sorry. We have patients with dementia with agitation, where you know their agitation is significantly increased if you're trying to get them out to go see a provider outside of their home setting. That they know.
Speaker 3:And then we have those really complicated patients that you know that are short of breath, with even five feet of ambulation. So you know getting out of the house is really difficult for them. And, just by the nature of what I am sharing, our patients are really sick and do require hospitalization more than others. But one of the things we pride ourselves on and we work on is trying to keep them out of the hospitals. Most of my patients don't want to go. The last thing they want to do is go to the hospital because they've been there A lot of times. They come back with a worse pressure ulcer than before going in, they come back with more confusion and delirium. So they've been through this so many times that they rather stay home. We rather keep them home. So we try to you know if something is going on. We try to get there same day or next day and get them seen so we can keep them home with their loved ones with the quality of life that they want.
Speaker 1:So this is the last question we're going to do about your current work and then we're going to get into some other tips that we want to talk about. Do you think this home visit thing is going to expand and where do you see medicine going in the next 25 years in terms of the patient-physician encounter?
Speaker 3:You know, I am hopeful. Like I was telling you, you know, the patient, the future of healthcare. It needs to be patient-centered, it needs to be value-focused and it needs to be prevention-oriented. And to get there, you know, one of the big ways to get there is through house calls and to be able to actually spend 45 minutes with the patient to see what matters to them, what are their values, getting those preventative measures taken care of.
Speaker 3:I think we need to go back to how we used to practice medicine. So you know, you said you were talking to folks about talking to a house call physician and they said, oh, my goodness, this used to be a thing of the past. I think we were doing things well and then we kind of got away from it. And now we need to reel it back and realize that it needs to go back to patient outcomes. It needs to go back to cost effectiveness, which is not our current healthcare system is not set up that way, and then the overall healthcare experience. And I definitely think that house call is a part of that, especially with how our population is aging.
Speaker 1:It's funny, even if you go back and watch old movies. It was almost romanticized right that somebody would get sick and they'd go to the kitchen phone and the doctor had the bag right and they would come over and the person would be— that was us.
Speaker 1:Yeah, exactly, and it was just—it was this key figure in the community and then suddenly, I guess somebody a business person, probably not a physician decided they should have a clinic and they should have records, you know, and that they should have schedulers, and anyway it all got out of whack.
Speaker 3:Well, look, it all got out of whack and now we need to go back to what actually truly worked. And you know, shout out to Harmony Cares, my company that's doing the good work.
Speaker 1:Yeah for sure, and, by the way, real quickly. Harmony Cares operates in what parts of Virginia?
Speaker 3:So we are throughout Virginia. We have our office in Richmond, virginia Beach, williamsburg, roanoke, nova, so we're pretty, and then even in Richmond, like I was telling you, we go up to Fredericksburg. So we're pretty spread out and you know, definitely would advise advice, would recommend folks to look us up.
Speaker 1:yeah, see the kind of aging well, um, you wanted to give some advice on aging, which I'm, I'm, I've got my pen and paper out, I'm ready to start taking notes. So what? What do people need to know to, uh, approach aging better?
Speaker 3:All right. So yeah, so tips from a geriatrician. I think the first one is you know, you know what I'm going to say. It's physical activity. So I have a patient I think I don't know if I said this earlier, but she's 100 years old and I love asking patients what can you tell me? Or how do I get to be 100 years old? You know, that's me just trying to get tips from my patients, but she told me I don't give up, I get up, so keep moving.
Speaker 3:It doesn't have to look perfect. It can be a 10 minute walk with your dog. It can be incorporating something like 10 squats while waiting on your morning coffee. You know, every morning you're waiting on your coffee, you do 10 squats. It doesn't have to be perfect looking and slowly you add in those longer periods of exercise. So you know, as we age, our muscle mass and the muscle strength continues to decline and we need to keep working on our resistance training. But again, it doesn't have to be. You know people get stuck on. Things have to be perfect and they don't. So my advice would be just don't slow down, as any of us. You know, it doesn't matter if you're 35 or you're 65, the more you stop doing something, the harder it is to get back to it. So just keep moving is my first advice.
Speaker 1:Well, you haven't heard me tell the story. I was at a meeting at UVA the other day and it was a group of scientists and somebody said will we ever have a pill for exercise? And a pretty prominent guy at UVA said that there were. It's not been published recently that with cancer therapy now there's a. It's scientifically proven that if you exercise, most cancer care has a 35% more effective rate, higher efficacy. And he said if we had a pill that did that, people would be lined up to take it. But if you tell people to exercise they don't do it. And I thought then I thought that seems like a pretty serious motivation just to know that that's that high of an effect on your overall health if you're going through cancer care, just the simple exercise. So you've got to. You know. Look, I'm trying to do better myself, as you know, but it sounds like good advice. Any other advice on aging, but it sounds like good advice Any other advice on aging.
Speaker 3:So the next one I would say is social isolation and loneliness have a very negative, a huge impact on physical and mental health. Are you familiar with the Harvard study of adult development, Brian?
Speaker 1:Vaguely, so tell me more about it, yeah.
Speaker 3:Yeah, so it's one of the longest running studies on happiness and well-being. Vaguely, so, tell me more about it. And significant finding in this study is that good relationships are paramount to happiness, health and longevity. So making those social connections, making sure you're not isolating yourself and that can be really hard when you know, when I have so many patients that say everybody I know has passed away and I'm all alone so I have a lot of patients that do go through that and we really try to focus on those social connections. But what I would encourage people to do is make sure you have your community and hold tight to your community and keep communicating your feelings, because that helps not just your mental but your physical well-being as well.
Speaker 1:Well, let me simply comment on that. I was listening to something yesterday, and it's a generalization, but there's some truth in generalizations, and that is that women are far better at this than men are, that women are pretty good at lifelong relationships and men are pretty lousy at it, not to say that some men aren't good at it. But one of the things that I would say on behalf of men is that it's up to us to look out for one another. I think this is where women just do a better job at it, that I think men tend to get isolated faster and we have an obligation to one another, whether it's organizing a get-together or simply calling somebody up or texting somebody. And don't you think that's sort of at the root of it that we've got to get back to—some of this gets back to the social media thing too We've lost—just like the doctor making house calls we've lost the sense of community.
Speaker 3:I hear you on this, I think you know, I think men need to raise, to rise up and have other men that realize that this is a problem, need to help other men get together and build a community. And I think women that realize that you know, if you have a partner that you start realizing is socially isolating themselves kind of you know you, and it doesn't have to be a push like, oh, you need to get out and do all these things, but showing them by example that community does matter and we all do better when we integrate ourselves in a society versus isolating ourselves in these little bubbles like we have recently.
Speaker 1:Or phones, isolating ourselves with our phones or our phones.
Speaker 1:Yeah, I think it's pretty easy to use that right. I mean, I see it in my own life that it's just really simple. You know it takes some effort to get out and go see somebody, go have lunch, have coffee, pick up the phone and call somebody, but it's far easier to go, you know, scroll and look at some story or Instagram or Facebook or whatever. I just still think that's the. You know I'm starting to sound like a boomer here, but it's certainly part of the problem. What's next on your list?
Speaker 3:I think my last advice would be finding purpose. So what I, you know, what I have seen with my elderly population, is when they lose that sense of purpose is when they lose hope. So, whether you know, and your purpose doesn't have to be something complicated, you have to find a sense of what makes you happy and it can be different at different stages of life. So you know, I don't know, for you it might be this podcast that gives you joy, or you know, everybody's situation is a little different. I truly enjoy my work, I'm sure you can tell, but everybody needs to find their purpose and it doesn't have to be really big.
Speaker 3:You know, I have, I go to these communities like assisted living communities, where I have. I have this one lady that she will cook and bring food for others in their community because you know, for someone to get a home cooked meal is not, you know, it seems easy but it's not. A lot of people in our community are not getting a home cooked meal. Um, so she will cook for them and she'll share her food and that is her little purpose and that gives her joy and that keeps her going.
Speaker 3:I have this other patient that helps one of my other patients make his pillboxes. So they're friends. You know they're now in their 80s but they've been friends since high school. They live in the same assisted living friends since high school, they live in the same assisted living and she helps him make his pillboxes because you know he has memory impairment. So it doesn't have to be really big, it doesn't have to be something you know, world changing. But even if you can, you know, I think honestly, I think most people just like to help others. So if you can find a way to contribute to the society and help others, that will help you keep going.
Speaker 1:I couldn't agree with you more. I think I'm going to get a bumper sticker and it's called Happiness is Found in the Service of Others.
Speaker 3:Look, can you get me one too?
Speaker 1:Yeah, when I get them printed I'll get you one. And I think that gets back to what I just said about social media that it's so easy to go down these rabbit holes of comparing your life to somebody else's and you never fill that hole. It's never ending.
Speaker 1:But when you go do something nice for someone else without any sense of recognition, it gives you a sense of purpose that social media or anything like that can never fill, and I feel like that. We used to do this with some degree of regularity. I'm not, fortunately. Well, I probably do qualify for geriatrics, but don't tell anybody Meaning. I'm old enough to remember when there was great senses of community.
Speaker 1:I grew up in a rural area where you know church and school and everybody knew one another and my wife and I talk about this that when people died there used to be this great outpouring of food and notes and people would visit. And now it's. You go on Facebook and it's thoughts and prayers. You know it's people just don't have the time to be inconvenienced. And I think that if we shake ourselves off from this sense of we're too busy and become less busy and commit ourselves to one another, that the happiness will be found from within ourselves just as much as it is whomever it is that we happen to be helping, and I think that's that. I think it's not just geriatrics, by the way. I think this works just as well for a 16-year-old as it does for an 86-year-old.
Speaker 3:I think this works just as well for a 16-year-old as it does for an 86-year-old. Yeah, the joy truly comes in the small things, not the doom scrolling that people talk about and comparison on social media. It really comes from small moments with our loved ones, with our community. And I think you know, I think, the preface of this, that this talk, you know, today I feel like it's all about going back to how maybe I'm a boomer too, you know, you said you feel like a boomer, but just going back to how society was.
Speaker 3:We've just kind of gotten away from things that truly matter. And you know one of the I just want to share things that truly matter. And you know one of the I just want to share. I see a variety of patients every day and the one thing that always in my mind, the people that are doing well, no matter how complicated their medical conditions are, versus the people that are not doing well, are the people that have a social structure and support in place, so you can have the same comorbid conditions, but if you have loved ones, if you have your things that you look forward to and enjoy, you are just. You know you tend to do so much better than folks, my folks that are isolated and all alone.
Speaker 1:Well, look, I don't know if you've got anything else you want to share. I know that I'm going to tell Dr Gupton that I'm glad you decided not to be a chemical engineer. I mean, look, we need plenty of chemical engineers too but it just sounds like you made the right choice to choose medicine.
Speaker 3:Yeah, no, I think this has been a wonderful conversation and I, you know, I'm very happy to share what I love and I hope this can help someone. You know, just focusing on finding your purpose, and it doesn't have to be big, like I said, just, you know, baby steps, helping somebody out, that is what our society really needs more of right now.
Speaker 1:That is what our society really needs more of right now. Well, look, this has been terrific. Pri, Is there anything?
Speaker 3:else you'd like to add before we wrap up? No, just want to thank you for this wonderful opportunity.
Speaker 1:Well, look, thank you not only for the chance to speak to you today, but thank you for what you're doing. And you know, look, I'm sure you don't. I know it's got to be difficult to get up every morning and try to get to the YMCA, but I'm sure you don't wake up every morning and search for purpose.
Speaker 3:I don't no, yeah and you know I tell myself, waking up and going to YMCA, I say you know, every morning I say nothing changes if nothing changes. So if we want to make a positive change, we have to change something. So that keeps me going and my patients keep me going. I'm very lucky.
Speaker 1:Well, thank you and keep doing what you're doing, and we're lucky to have you.
Speaker 3:Thank you.
Speaker 1:Thank you. Thank you for listening to the Virginians of Interest podcast. If you like what you've heard today, please be sure to download, like and subscribe.
Speaker 2:Thank you for listening to the Virginians of Interest podcast. No-transcript.
