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Arkansas Living June 2011 : Page-12

BY S HEILA Y OUNT Dr. David Lipschitz Health Care Revolutionary Photos by Gary Bean T 12 hree years ago, Dr. David, the renowned geriatrician, reached a mile-stone once considered a true sign of aging. “The geriatrician has become geriatric,” he wrote in his 2009 book, “Dr. David’s First Health Book of More (Not Less),” as the then 65-year-old Little Rock-based physician acknowledged that he had received his Medicare card and his fi rst Social Security check. But for Dr. David Lipschitz, being “geriatric” is far from a bad thing. “We are not old, we are fabulous,” the now 68-year-old Lipschitz says in his lilting South African accent during an interview at his offi ce at the Longevity Center at St. Vincent. “And that’s the thing. We need to look at ourselves and think, ‘Man, aren’t we great?’” With the fervor of an evangelist, Lipschitz has long been spreading the message that one can age in a healthy way. Today, he continues to carry that message and to develop what he calls a “new model” for health care as executive director of the Longevity Center at St. Vincent in Little Rock. But his title falls far short in describing the true scope of his work. In addition to being a hospital administrator, he is a practicing physician, author of books and syndicated newspaper columns, as well as a much in demand speaker who regularly appears on television and radio programs. Through these various channels, he always carries his positive view of aging, which is delivered with his trademark sense of humor. But his enthusiasm is tempered with warnings. Baby boomers are becoming “geriatric” and will test that system like never before. Doctors order too many tests  , 585$/$5.$16$6/,9,1* JUNE 2011

Dr. David Lipschitz Health Care Revolutionary

Sheila Yount

THree years ago, Dr. David, the renowned geriatrician, reached a milestone once considered a true sign of aging.<br /> <br /> “The geriatrician has become geriatric,” he wrote in his 2009 book, “Dr. David’s First Health Book of More (Not Less),” as the then 65-year-old Little Rock-based physician acknowledged that he had received his Medicare card and his fi rst Social Security check.<br /> <br /> But for Dr. David Lipschitz, being “geriatric” is far from a bad thing.<br /> <br /> “We are not old, we are fabulous,” the now 68-year-old Lipschitz says in his lilting South African accent during an interview at his offi ce at the Longevity Center at St. Vincent. “And that’s the thing.<br /> <br /> We need to look at ourselves and think, ‘Man, aren’t we great?’” With the fervor of an evangelist, Lipschitz has long been spreading the message that one can age in a healthy way. Today, he continues to carry that message and to develop what he calls a “new model” for health care as executive director of the Longevity Center at St. Vincent in Little Rock. But his title falls far short in describing the true scope of his work. In addition to being a hospital administrator, he is a practicing physician, author of books and syndicated newspaper columns, as well as a much in demand speaker who regularly appears on television and radio programs.<br /> <br /> Through these various channels, he always carries his positive view of aging, which is delivered with his trademark sense of humor. But his enthusiasm is tempered with warnings. Baby boomers are becoming “geriatric” and will test that system like never before. Doctors order too many tests And Americans take too many drugs. Rural Arkansans need better access to the medical system.<br /> <br /> In short, it’s time for a health care revolution, Lipschitz says. In his view, the revolution includes a positive view of aging and a profound change in the way doctors practice medicine.<br /> <br /> A man in motion<br /> <br /> It’s 8:22 a.m. on a Wednesday morning in April and Lipschitz is holding court at the Vincent DePaul room at the St. Vincent Infi rmary Medical Center. It’s part of the hospital’s popular “breakfast with” speaker series.This morning it’s standing room only with attendees representing a mix of ages from baby boomers to the World War II generation.They listen intently as Dr. David discusses insomnia and its many causes.<br /> <br /> “It’s a huge problem,” he says. “Half of Americans suffer from insomnia.” The causes of insomnia include a “lousy lifestyle,” growing older, depression, drugs and alcohol, and illnesses, Lipschitz says.Surprisingly, he notes that a major offender is diphenhydramine, which is the active ingredient in such drugs as Benadryl, Tylenol PM and Advil PM.<br /> <br /> “Everybody who can’t sleep goes to the store and takes a PM, but a PM is as bad as a lousy BM,” he says, prompting laughter from the audience.<br /> <br /> The problem with the “PMs” is that they leave you feeling fatigued the next day, Lipschitz warns. Fatigue means reaction time is reduced and for older people, that can be especially dangerous and even lead to accidents.<br /> <br /> Alcohol also interferes with sleep, he tells the group.<br /> <br /> “Alcohol puts you to sleep but the quality of sleep is terrible,” he says, adding that having just a single drink after 8 p.m. can disrupt sleep.<br /> <br /> Instead of relying on drugs, Lipschitz urges the attendees to find the underlying cause of the sleep disorders, which can include sleep apnea, a condition he recently learned he has and that is treated with a machine that assists breathing.<br /> <br /> “Try and fix it by having a better lifestyle,” he says. “Let’s forget the idea that the solution is a pill.” With that admonition, he is done with his presentation, but graciously remains to take a few questions before heading off to a meeting.<br /> <br /> It’s two weeks later and Lipschitz has arrived at KARK, Channel 4, shortly before noon for the live call-in show, Health Matters.<br /> <br /> The program airs each Friday as part of the station’s noon show. Lipschitz, dressed in his white coat, is in his typical jovial mood as he banters mischievously with the Channel 4 noon crew, calling veteran television personality Tracy Douglass “a legend.” He then quickly shifts gears to go live on the air with anchor Wendy Suares to discuss a recent study on organic foods. Next he takes calls from viewers asking about skin rashes, allergies and diverticulitis.talks about aging and weight gain and how men age better than women, but don’t live as long.<br /> <br /> “I’d rather age less well and live longer,” he quips.<br /> <br /> After the show, it’s back to the Longevity Center’s clinic where he will see patients. First on the list is Therman Talbert of Benton. At age 82, Talbert is in for a follow-up visit. He has been one of Lipschitz’s patients since the late 2000s.<br /> <br /> Lipschitz takes a seat in front of Talbert and begins asking a series of questions.<br /> <br /> “One of the most important things for the modern day physician is the capacity to type like a court stenographer and I am really good at that,” he says as he types away on a small notebook computer.<br /> <br /> After asking about how Talbert is tolerating his blood pressure and cholesterol medications, Lipschitz switches to his family life.<br /> <br /> “And you are widowed and divorced?” Lipschitz asks. “How is your girlfriend doing?”<br /> <br /> “She is deceased,” Talbert answers quietly.<br /> <br /> “Oh no, when did she die?” Lipschitz says.<br /> <br /> “July 19 of last year,” Talbert says.<br /> <br /> “Are you dating now?” Lipschitz says.<br /> <br /> “No. I am just available,” Talbert responds.<br /> <br /> “Are you coping OK being alone? Because men can’t be alone,” Lipschitz says.<br /> <br /> Talbert responds that he is doing fi ne. “I am just hard headed,” he adds.<br /> <br /> Lipschitz goes on with a physical examination, listening to his heart and lungs, and declares him to be in good shape.<br /> <br /> “You are fabulous,” he tells Talbert. “You are a knockout.” After the examination, Lipschitz returns to his offi ce where he fi nishes uploading information on Talbert into the hospital’s computer system. Talbert says he likes Lipschitz’s approach.<br /> <br /> “He has a positive approach to everything … you trust in him, you believe in him and to me that’s important,” Talbert says.<br /> <br /> Learning to listen<br /> <br /> A key part of Lipschitz’s philosophy for health care is the ability to listen to patients.<br /> <br /> It is an approach he was taught as a young man in the 1960s at the University of Witwatersrand medical school in Johannesburg, South Africa. There, Lipschitz says he and his fellow medical students were taught to be “bedside physicians fi rst” and to use their brains to make decisions rather than relying on tests.<br /> <br /> “We were taught that everything could be learned through a medical history and evaluation,” he says, adding that tests were to Be used primarily as a back up to confi rm the diagnosis.<br /> <br /> From there, he went to work in research in hematology and iron metabolism, studying with the world’s leading authorities in those two areas – Dr. Thomas Bothwell of South Africa and Dr. Clement Finch of Seattle, Wash. He earned his Ph.D. and then came to the United States to work further with Finch doing research in hematology. Next he moved to the University of Arkansas for Medical Sciences (UAMS) to do bone marrow research. While doing that work, he began to look at the effect of aging on the body, which led him to the then new fi eld of geriatrics.<br /> <br /> During this time, he met Dr. Eugene Towbin at the Veterans Administration Hospital. Towbin was a pioneer in geriatrics, which is the clinical care of older people, and gerontology, the study of the aging process.<br /> <br /> Towbin encouraged Lipschitz to enter the field.<br /> <br /> Lipschitz did just that and has distinguished himself in the fi eld, helping to establish the Donald W. Reynolds Department of Geriatrics and Institute on Aging at UAMS.In 2009, he left UAMS to head the Longevity Center at St. Vincent. In addition, Lipschitz, who has been described as the “Dr. Spock of Aging,” has written two books, writes a Sunday column for the Arkansas Democrat- Gazette, appears on TV and radio programs and has a website, www.drdavidhealth.com.<br /> <br /> Lipschitz says he decided to leave UAMS because it was time for new leadership there and he had new goals he wanted to pursue.<br /> <br /> “I have never believed that someone should lead a program indefi nitely,” he says, adding that if someone stays too long in a program it “plateaus and then deteriorates.” <br /> <br /> At St. Vincent, Lipschitz says the focus is different.<br /> <br /> “The focus is purely on patient care, marketing and recruiting,” he says. “It is less on teaching and less on scholarship. So we are trying to develop models of care.”<br /> <br /> The new models are necessary, he says, because the nation’s health care system is sick.<br /> <br /> At the precipice<br /> <br /> <br /> With millions of baby boomers heading toward retirement, the nation’s health care system will be tested as never before, Lipschitz says. In addition to demand, infl ation of health care costs is expected to continue.<br /> <br /> “We are spending $2.6 trillion on health care and it is going to go up by 10 percent every year,” he says.<br /> <br /> In addition to rising costs, the nation’s health care system is experiencing a shortage of primary care doctors, Lipschitz says.<br /> <br /> “The average primary care doctor is in his or her late 50s,” he says. “The primary care doctors are retiring in droves. And there is no one replacing them and that’s because the way we train young physicians is abominable.”<br /> <br /> Lipschitz laments that there is no incentive to practice primary care and the majority of medical students now go into the more lucrative specialist fi elds. He adds that primary care doctors, like him, are undervalued.<br /> <br /> “I am the most important member of the health care community even though nobody thinks I am,” Lipschitz says. “As a specialist in primary care, I am capable of dealing with the vast majority of acute and chronic medical problems.” Finally, Lipschitz says the health care system isn’t practicing the right medicine. He noted that it is estimated that about half of all health care costs are unnecessary. But cutting the budgets of Medicare and Medicaid isn’t the answer, he notes.<br /> <br /> “Nobody seems to have any idea that Medicaid serves people in need,” he said.<br /> <br /> The right medicine<br /> <br /> At the St. Vincent Longevity Center, Lipschitz and his staff are busy working to “practice the right medicine,” Lipschitz says.<br /> <br /> “We want to reform health care at St. Vincent. No one believes me and they think I’m a nut, but in fact it is not hard,” he says.<br /> <br /> At the Longevity Center, the focus is on aging baby boomers and their parents. The goal is to help them maintain good health and independence as they grow older. It also offers on-site specialty programs for nutrition counseling, stress management, fi tness assessment and medication interaction.<br /> <br /> “People come here to stay healthy, not because they are sick,” Lipschitz says.<br /> <br /> Lipschitz said the staff seeks to empower its patients and encourage them to ask questions.The center’s primary health care doctors fully coordinate and oversee all aspects of their patients’ care.<br /> <br /> “We want to be responsible for your care,” Lipschitz says. “And we want to help you seek the involvement of an expert only if needed … Nobody should have minor problems such as high blood pressure managed by a heart doctor. Multiple visits to a heart doctor, the rheumatologist, the endocrinologist and the gastroenterologist are inappropriate.”<br /> <br /> Tests are done judiciously, Lipschitz says, adding that such things as cholesterol tests are not required every year. Even an annual mammogram isn’t necessary if you do not have risk factors for breast cancer.<br /> <br /> Couple care is also stressed at the center, Lipschitz says, adding that he tells patients over the age of 70 to never go to the doctor alone.<br /> <br /> “If you are married and you bring your spouse, fi rstly you get a far better insight into what health care problems you each have,” Lipschitz says. “I ask the husband, ‘How are you doing?’ and he says, ‘I’m great’ and then the wife says, ‘Tell him the truth, Bert.’”<br /> <br /> His dream for rural Arkansas<br /> <br /> Although Lipschitz is helping reform health care at the center, he wants to do more.He wants to move beyond the clinic setting and even media outlets, such as newspapers and television, to reach out to the rural communities where the shortage of doctors is critical. One way is through the Internet, he says.<br /> <br /> “You know how ineffi cient it is for me to get in a car and go to 20 farms to see people who are sick?” Lipschitz says. “I can talk to hundreds of people from my desk.” <br /> <br /> He uses the example of his 88-year-old mother, Hanid, who lives in South Africa.Through the Internet program Skype, he talks to his mother via computer and can see her on the computer screen in real time.<br /> <br /> “I call my mother, ‘How are you?’ ‘I’m fi ne.’ I look at her and she shows me the rash on her arm. She tells me this, she tells me that.She is 88 and independent in South Africa,” he says, adding he would like to do that with rural Arkansans as well.<br /> <br /> Through such a long distance clinic, he could see the patient via a computer from his or her home and ask questions. Blood pressure measurements could be taken by the patient or a nurse and then uploaded to the computer and sent to a doctor or nurse to review. But before such a system can be fully developed, people living in rural Arkansas need better access to broadband Internet and computers.<br /> <br /> “That’s my dream,” he says. “That’s the future and that’s what I do. I want to communicate with Arkansans in all areas, but particularly with the poor and particularly the disadvantaged.”<br /> <br /> But Dr. David’s revolution will take time, and he acknowledges it is likely more time than he has. Although he fervently says he is in his prime and has no plans to retire, there’s a sense of urgency lurking underneath his carefree and playful demeanor.<br /> <br /> “The thing about being 68 is that I am impatient,” he says wistfully. “The older you get, the less time you have.” •<br />

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