Patient wellness more reliant on 'lifestyle management' than biologic therapies
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A greater focus on health and wellness could have quantifiable benefits in patients with rheumatologic diseases, according to a presenter at the 2020 Association of Women in Rheumatology National Conference.
“We have to accept that there is a discordance between what doctors pay attention to and what patients pay attention to,” Leonard H. Calabrese, DO, chief medical editor of Healio Rheumatology and professor of medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, told attendees. He noted that doctors order labs and measure swollen joints, while patients care about parameters including fatigue, emotional distress and “lousy sleep.”
“When you ask patients how they are doing, and they put that number down on the 0-100 scale, and then you write your number down, when you look at almost half the visits in most studies, the patient and the doctor diverge by more than 25 points,” Calabrese said. “Is that meaningful? Yes, it is.”
Calabrese explained what he believes this disparity means. “The vast majority of the time, patients say they are doing worse than we think they are doing,” he said.
Understanding how patients feel is the first critical step to promoting wellness, according to Calabrese. “Many patients report: I do not think this provider heard what I had to say,” Calabrese said. He challenged AWIR attendees to make empathy a tool of patient care.
“Empathy is our ability to stand in our patients’ shoes for a minute,” he said. “We need to make our patients believe they have been listened to.”
Some clinicians argue that available therapies are more than sufficient to achieve disease control in most patients, and that with improved disease control come improvements in those wellness parameters that are so important to patients. “There may be a worthwhile argument for that,” Calabrese said.
But he argued that treatments are not perfect. “Somewhere between one in seven and four in 10 patients do not get into remission,” Calabrese said. For these patients, and even for those who do achieve remission, a greater focus on health and wellness can and should be a critical component to care.
Another consideration is that the rheumatology community, as a specialty, needs to define what wellness means more specifically. “Wellness means a lot of different things to a lot of different people,” he said, suggesting that it can imply everything from a healthy diet to meditation. He then offered his own definition. “Wellness occurs when lives go well.”
There is no “secret sauce” to achieving this outcome, according to Calabrese. “Don’t smoke, don’t take poisons, manage your weight, eat healthy, exercise healthy, sleep well and try to have a good mental outlook,” he said.
A significant body of data shows that each of these approaches individually, and all of them taken together, can have significant health benefits in patients. “But if it is so well known, why doesn’t everybody do it?” he said.
There is at least one answer to this question. “Because doctors are not talking about it,” Calabrese said.
Rheumatologists need to make the mental adjustment from a traditional model of care to a new patient-centered model of care, according to Calabrese. “It involves more than just using biologics,” he said. “It is about making sure their needs are met and dealing with health literacy. They don’t need another biologic. They need lifestyle management.”
Calabrese acknowledged that limited time in the clinic can prohibit clinicians from having the wellness discussion with their patients. Training is limited, and many rheumatologists wonder whether it is within their purview. “These are valid criticisms,” he said. “But we need to find ways to work around this. If you tell patients that you believe in wellness, you will get some patients started.”
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Calabrese L. Lifestyle Approaches and Wellness in Patients with Rheumatic Disease. Presented at: AWIR National Conference; August 13-16, 2020; (virtual meeting).
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