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Health care reform can start with patients


by: PAMPLIN MEDIA GROUP PHOTO: NEIL ZAWICKI - Nurse Practitioner Kim Tinker advocates a healthy and active lifestyle. She leads one herself.The stated objective of Gov. John Kitzhaber’s health care reform project is to produce better quality care, achieve better patient outcomes and save money. Kitzhaber, a former emergency-room physician, calls this “the triple aim.”

These are good goals, to be certain, and within the framework of a health care system, the way in which patients are treated is crucial to dialing in the most effective care possible. But the state examination of the system is an opportunity for patients themselves to examine their pulse, and to consider their relationship with health issues, doctor visits and lifestyle choices.

Kimberly Tinker is a nurse practitioner with Clackamas County and the care provider for the School-Based Health Center at Sandy High School. She said education and lifestyle awareness are key to better health and quality of life. Further, she offers some surprising statistics concerning public health.

“The majority of your health care dollars are spent in the last nine months of your life,” Tinker said. “Most of the things you’re treated for during that time are the product of lifestyle choices.”

Tinker said the fact that people spend most on health care toward the end is an indication of our cultural attitudes, and that there are simple and inexpensive ways to achieve better health ahead of needing to go to the doctor.

“If we do more education and more preventive medicine, versus treating chronic diseases,” Tinker said, “then hopefully we’ll have more people with less chronic diseases, and using less healthcare dollars.”

Tinker added that we need to change our focus to trying to create healthy people, rather than just chasing diseases.

Trying to create healthy people can be a tall order in a culture loaded with convenience. With fast food, an automobile culture and sedentary entertainment choices, Tinker says many patients tell her they simply don’t have the time or the money to be healthy.

“I hear people all the time say, ‘I can’t afford to eat healthy,’” she said. “But a bag of lentils will make multiple meals. I think a lot of the problem is that people stopped learning to cook.”

Tinker said the deliberate nature of cooking from scratch lends itself to a healthier lifestyle all around.

“I mean, crock pots,” she said. “Take them off the shelf. It takes more forethought, it takes some time for preparation, but in the long run, you’re getting a better benefit.”

The opposite of living a simpler, more active life and eating well, Tinker said, has led to obesity statistics not known just a generation ago.

“It’s really sad when you read statistically that so many children (who remain obese) are not going to outlive their parents,” she said, pointing to the rise in type 2 diabetes, a potentially fatal condition thought be linked to a metabolic syndrome.

“So, they have high blood sugar, high cholesterol,” she said. “This is totally something that can be fixed with lifestyle changes. These kids do not need to grow up and be adult diabetics.”

Good advice, but how to detect such problems and then help people to change? One way, Tinker said, is through the School-Based Health Center. Here, she and her colleagues screen patients for a battery of lifestyle habits, from healthy eating to exercise to drug, alcohol and tobacco use and even brushing and flossing.

“From doing this, we can zero in on areas where they can make improvements,” Tinker said.

Such understanding of lifestyle habits will go a long way toward creating a more healthy society, but Tinker allows it is not an instant thing.

“You know, taking a 55-year-old and telling him to start walking every day is not as easy as helping a child to develop these habits,” she said. “And believe it or not, when you educate children, you’re getting parental changes as well.”

Asked how to get children to adopt new habits, Tinker gives a simple formula:

“Consistency, consistency, consistency, and repetition to the point of boredom,” she said. “The most rewarding part of this job is when I see people make lifestyle changes. It’s the hardest pill for people to swallow, yet it’s the least expensive.”