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Achieving Goal Congruency by Charles Whitney, MD, and Daniel A. Bobrow, MBA

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Dental practices, especially those committed to oral systemic health, are uniquely positioned to improve the health of America. Your patients and community, as well as your professional referral network, all benefit when your practice adopts a third-era model to enhance both physical and fiscal health.

Periodontal infection, whether inflammation is present, has been associated with an impressive (and growing) number of systemic conditions and diseases including: diabetes and pre-diabetes, hypertension, heart attack, stroke, stillbirth, pre-term labor and high blood pressure. Until insulin resistance is addressed and treated, it is difficult to eradicate this infection.

Insulin resistance raises blood sugar and, eventually, might lead to diabetes. Evidence suggests that a skilled hygienist can administer expert therapy and yet, until glucose metabolism is normalized, be unable to eliminate infection and inflammation.

Dietary and other health choices leading to obesity and preobesity are the main causes of most insulin resistance (Fig. 1). In fact, they are the mother and father of many preventable systemic diseases.

Curing obesity can cure insulin resistance and prevent diabetes. It also leads to greater success with eradicating periodontal infection and inflammation. Few will argue with the goal and benefit of achieving a healthy weight. The question for many remains how to do it.

Physicians continue to react to diseases by prescribing medication for high blood pressure, hypertension and diabetes. Once a person is diagnosed with diabetes, there has been a significant destruction or disabling of insulin-producing beta cells in the pancreas.1

The medical community remains ineffective at treating insulin resistance because most physicians lack the time and ability to effectively treat obesity. In fact, 79 percent of primary care physicians have never been trained to counsel a patient about obesity.2 Patients are simply asked to eat less and move more. Of equal concern, talking about obesity has become a taboo subject to broach with many patients.

Fortunately, it is a simple matter to acquire and master the verbal skills to incorporate this conversation into your patient treatment protocol. Here is an example of a script to introduce health coaching to a patient.

Doctor: As you know, our practice has made a commitment to helping our patients achieve total health and wellness for themselves and those they care about.

We’ve known for some time that it’s difficult to treat gum inflammation in the presence of high blood sugar levels, and gum inflammation can increase the risk of many systemic diseases such as heart attack and stroke.

True Health is a solution to help patients reach and maintain a healthy weight. Everyone gets a personal coach to guide them through the program. It’s cost-neutral, safe, surprisingly easy and highly effective. Would you like to learn more about it?

The graph3 (Fig. 2) illustrates the typical health path. People are, for the most part, born healthy. Between birth and death, we are either healthy, sick or (and this represents a revelation to many) non-sick. Non-sick refers to the period of time, which precedes the manifestation of disease symptoms. As we already know, people do not suddenly acquire cardiovascular or periodontal disease. It is a process. Were the consequences of poor health choices, such as eating the wrong food in the wrong portions immediately known, it’s likely people would not make such choices.

When people make choices that lead them toward, instead of away from, health, they follow what is termed the New Health Path, one in which optimal health is maintained until shortly before death. Unfortunately, assuming current trends, the nation’s Forecasted Path predicts more illness occurring sooner. The good news is that this can and must be reversed and, by incorporating a Third Era of Medicine model into your practice, you are part of this solution.

An Extremely Abridged History of Medicine

The practice of medicine may be characterized by three distinct eras. The First Era ended with the advent of the germ theory of disease, which led to cures for many infectious diseases through the use of antibiotics, immunizations, medical hygiene and improved public health. Regrettably, we remain largely stuck in the Second Era of Medicine, as most in the medical profession continue to focus on reacting to end-stage disease symptoms, ranging from bleeding on probing and deep pockets in the dental profession to a cardiac event in the medical setting.

This Second-Era mindset in the presence of the current diseasecausing obesity epidemic is bankrupting our health-care system, as well as our economy. The toll, in terms of suffering, diminished quality of life and longevity, is truly incalculable.

It is incumbent upon all health professionals to move into the Third Era of medicine where the focus is on creating health, not just reacting to poor health and supervised neglect.

Curing obesity and pre-obesity by helping our patients first recognize the numerous health choices being made on a daily basis, then coaching them on how to make healthy choices to attain and maintain a healthy weight, leads to a happy and appreciative patient, one who not only makes a positive contribution to the productivity of our society, but also serves as a walking billboard for the practice that helped them succeed at achieving optimal health.

An oral systemic mindset is first and foremost about recognizing that dentistry is as legitimate a medical sub-specialty as are orthopedics, obstetrics, otolaryngology and ophthalmology. All health professionals owe it to their patients to employ a collaborative approach to care to the benefit patients, your practice and society.

Coaching your patients to health is one the best ways to foster collaboration among your colleagues in the medical profession. When one of their patients, with whom they had little success achieving a healthy weight, presents for their next appointment looking (and being) the picture of health, and the patient shares that this was done by their dentist/hygienist, you can imagine the positive impact this makes. The physician will want to know more, and the door is open for you to grow your collaboration (and referral) network.

In November 2011 the New England Journal of Medicine published a study demonstrating that, when a person possesses both a learning tool for achieving a healthy lifestyle and a health coach to work with and support them, they are significantly more likely to maintain long-term weight loss than those provided with only the learning tool. Yet, even with the benefit of a coach, those patients with Class II obesity were only able to lose an average of 10 pounds after two years.

Dr. Wayne Andersen intuitively understood this information 13 years ago when he left a lucrative job at the worldrenowned Cleveland Clinic. He created an effective coaching, and best-in-class learning system he calls The Habits of Health. He knew studies* showed that people who use a portion-controlled meal replacement (PCMR) program succeeded at losing weight. However, 85 percent of these people regained the weight they lost because they returned to the habits of disease that led to their original weight gain.3

Dr. Andersen added safety studies and his coaching and learning programs to the PCMR, and created a comprehensive optimal health program. Individuals and practices can easily implement it at virtually no cost (the patient/client merely shifts their grocery budget from one basket of food to another). Health professionals coach as little or as much as they wish, typically assigning the responsibility for coaching to the hygiene department.

The effective oral-systemic practice need not be a financial loss leader. On the contrary, it can create a healthy revenue stream for all involved by offering a professional coaching service to those of your patients, as well as prospective patients.

* More studies are available for review at www.dannybobrow.tsfl.com/?page=hp-clinical-studies

References
  1. http://www.bashaar.org.il/files/21408200682610.pdf
  2. Dr. Mark Nelson
  3. Habits of Health by Dr. Wayne Scott Anderson. Habits of Health Press. 5/15/2010
Author Bios

Dr. Charles Whitney will be a featured presenter at the Third Annual AAOSH Scientific Session held from September 20-22 in Las Vegas. Learn more at www.AAOSH.org.

For more information contact Mr. Daniel Bobrow at DBobrow@OralSystemicHealth.com.

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