Making house calls to strengthen health care
: The Wall Street Journal’s Career Journal features a Q&A with Risa Lavizzo-Mourey, CEO of the Robert Wood
Johnson Foundation.  A specialist in geriatrics who once co-chaired an advisory White House
task force on healthcare reform, Risa Lavizzo-Mourey feels passionately about the business of health.

Q: Why did you choose to specialize in geriatrics?

A: I had an interest in health policy and a realization that, as
an academic physician, one of the things you’re always looking to do is
to have your clinical interests and your scholarly interests overlap
and reinforce one another. So given an interest in health policy and
the importance of Medicare in setting a national agenda for health
policy, it made perfect sense to pursue geriatrics. And once I started
working with older people, I realized how much I enjoyed the
intellectual challenge of taking care of patients who have multiple,
complex medical problems.

Q: Then you went back for your M.B.A. Why did you see that as important?

A: I decided to go back because I realized in
order to be involved in health policy, you really had to understand
more than the individual patient that we as physicians, are taught to
think about. You really have to understand populations and how the
environment influences the patients in front of you. And one way to do
that is to pursue public health. And another way is to pursue economics
and business and try to understand the statistical patient, the plural
patient. So I chose to go to business school, and it’s served me well
because it has allowed me to see the ways in which business, clinical
practice and health policy at the governmental level really do interact
to influence how healthy people are and the kind of health care that
they get.

Lavizzo-Mourey has also become known as an advocate of bringing back the house call, saying that today’s medical bureaucracies haven’t replaced those personal, essential services:

Q: Did you gain any insight from home visits?

A: One situation that gave me real insight into how
the environment we live in affects our health in profound ways was a
house call to an older patient. It was around holiday time and I was
making frequent visits to make sure she was doing well. Older patients
who live alone can become depressed. I noticed she was losing weight
and there wasn’t a good reason. She was getting Meals on Wheels but
they only come once a day and don’t provide any extras that you may
need to keep your weight up. When I asked her about it, she didn’t have
a good reason why she was losing weight. So I asked to look in her
refrigerator and saw it was empty. This woman had to rely on the
system, she had no family to help her do things like go shopping. These
are things we take for granted.

Avoiding Menopause “triggers”; Kate Bracy at shares a recent study from the French National Institute of Health and Medical Research, that found identifiable “triggers” for common menopause symptoms. Some of what thy found may sound familiar:

The study followed the women from 1990 to 2000 and sent them a questionnaire every two years that asked for information on their dietary habits, smoking status, body measurements, medical history, use of hormone treatments and menopausal symptoms. What they discovered was that menopausal symptoms were associated with several factors, including some that were voluntary.

Women who smoked or drank alcohol were more likely to
have symptoms, as were those who ate sugary snacks. They also found the
risk of symptoms higher in women with benign thyroid disease, migraine
and depression, but these are not modifiable factors. Since this was a
large study done over a decade, it gave a lot of information about the
cohort who participated. The more we know about risks, the more we can
make choices that reduce them.

This research confirms what other studies have suggested – that
women can, to some extent, lessen their risk of having menopause
symptoms. At the very least we can quit (or cut down) smoking and
drinking alcohol. We can find healthy substitutes for rapidly absorbed
sugars in our diets, and thereby reduce symptoms or perhaps keep them
at bay. While we wait for more good research to help us make right
decisions, we can take matters into our own hands. Put down the drink,
the cigarette and the doughnut – it may help you say “whoa” to
menopause symptoms.

Great New Book: The Smart Woman’s Guide To Midlife & Beyond – A No-Nonsense Approach To Staying Healthy After 50. And the rest may is both up-to-date and rooted in common sense:

Physicians Janet Horn and Robin H. Miller have written a
book dedicated to women going through the changes mid-life brings, and
it’s a welcome addition to the self-help market. As the authors make
clear, the book is not aimed at keeping one forever youthful, but
rather at enjoying the age one is. They lay out health information and
advice in clear well laid out chapters, and I particularly enjoyed the
inclusion of alternative and complementary health therapies, as well as
differing viewpoints on controversial subjects like hormone therapy.

Horn and Miller have been friends for over twenty years, and one of
the charms of the book is their running conversation on different
medical issues and little anecdotes on how they’ve misinterpreted
symptoms in themselves over the years. They also share stories of
various patients with different ailments (names changed, of course),
and the result is a manual full of medical advice that is nevertheless
easy to read…

The topics range from understanding such critical systems as the
brain, the lungs, and the GI tract to addressing what happens to the
skin as we age and the various methods available to reverse signs of
aging. Dr. Miller has a fellowship in complementary and alternative
medical therapies and suggestions about helpful supplements or
therapies like acupuncture are not only included for each health topic,
they rate a chapter of their own. I found the list of supplements and
vitamins and how they may be used to be one of the most helpful
sections of the book, particularly since a discussion of what studies
have been done to prove efficacy is included. A reference that
discusses both standard medical practice and possible alternative
treatments for various conditions fills a useful spot on my bookshelf!

By Chris Lombardi

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