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It has been an interesting week of Christmas festivities, diabetes fiasco's and pedometer testing at our house this week. After a short run with my 10 year old son, mopping our second floor kids bedrooms, and hanging some new holiday wreath bling around our house, I quickly got myself to 10k steps by 2 pm.
Our Surgeon General recommends 10k steps a day in this very old website post here. It is easy to tell the post is dated since they are discussing " clipping a pedometer onto your belt" So 2001. Then they go on to whine about how difficult it is to get there. And I agree that I am not the typical sedendary adult. I'm a super motivated health hacker pediatrician who has high expectations of myself. Thus, I have high expectations of my patients. Here is my rationale in setting the bar so high for the v1... We have sat on our preverbial health laurels for way too long, with two generations of family practitioners and internists making vague recommendations about exercise, then proceeding to prescribe metformin, possibly lisinopril, then happily scheduling a sure to be paid for followup since the patient now has DIABETES and HYPERTENSION.
We need to have high expectations of our patients and PRESCRIBE 10k daily steps YEARS before that prediabetic patient showed up in our offices! Patients CAN DO THIS! We need to help them by leading an example, doing our 10k steps daily, then sharing those experiences with them. This is the kind of healthcare leadership we need these days in order to move into the new era of accountible care.
There has been a recent blur of commentary in healthcare about the risks of coming in to employment in healthcare systems. The most read post on Medscape this week was " Five Risks of Being an Employed Doctor" This dovetails nicely with Dave Chase's recent prediction that 50% of hospitals will closes by 2020. The obvious concern with hospital employment if Dave's assertion is correct, is that employment is not a safe bet either for physicians. So choose your system carefully.
So what could happen if all of us in the little ole U S of A, with a little effort and a couple of ankle sprains thrown in here and there, started walking 10k steps a day with the help of an addictive mobile app that enables self care? Would the streets be flooded with walkers in rural areas even in the winter? Would we have to build more sidewalks? What would happen to everyone's blood sugars, collectively? Manny Hernandez type one diabetic and founder of Tu Diabetes has a thrilling project entitled Big Blue Test, in which we ask diabetics to check their blood sugar, walk a brisk 20 minutes and then check their blood sugar again. It doesn't take the CMO or CMIO of a major health system here to figure out what happens when muscles burn sugar to contract while you are walking.
So if the entire US of A started walking 10k steps a day for the next 30 days, what happens next? OUR COLLECTIVE BLOOD SUGAR DROPS. When my type one diabetic daughter exercises for an hour her blood sugar drops 100 points! Now she is stuck with insulin for the rest of her life, due to a screwey immune system that killed her pancreas. Leave type one's out of it for the sake of this discussion. But what about the type two PWD walking around out there in masse? What if we included the hoards of them that haven't been diagnosed, walking around ticking time bombs with blood sugars in the 3 to 400's?
What if all of the t2 PWD in the USA began walking 10k steps a day? How many would eliminate their need for insulin ( some of them certainly would, as did a contestant from the Biggest Loser on season 3) , How many would get off Metformin? How many could avoid quarterly endo visits for good? How many could avoid blindness, disability, and death?
Now before you say I'm being sensational, let's go back to healthcare costs here... 80% of healthcare costs come from lifestyle disease, some have quoted. How have we collectively missed something so simple? If you are serious about the health of your population and want to get to outcomes in 2014, try our beta for a spin and get going on your 10k steps a day! We'll adjust later for special groups from there, but don't let a few sprained ankles here and there scare you off! Please feel free to sound off in your comments below!