Urgent Care vs. Emergency Care: Do You Know Where to Go?

Additional Info

• Segment Number: 5
• Audio File: ER_101/1524er5e.mp3
• Featured Speaker: Ryan Stanton, MD, FACEP
• Organization: American College of Emergency Physicians
• Guest Bio: Dr. Ryan Stanton is an emergency physician at Baptist Health Lexington in Lexington, Kentucky. He is the recipient of ACEP's 2012 National Spokesperson of the Year Award, 2014 911 Network Member of the Year Award and was named 2012 Lexington Young Professionals "Rising Star" Award.
• Transcription: RadioMD Presents: Dr. Leigh Show | Original Air Date: June 12, 2015
  Host: Leigh Vinocur, MD
  
  RadioMD. RadioMD.com. Spokesperson for the American College of Emergency Physicians. She's Dr. Leigh, and the Dr. Leigh Vinocur Show.
  
  DR. LEIGH: Hi, welcome back to the show. We have a very esteemed guest I am honored to have on. He's talking about his latest book, which is Disease Proof: The Remarkable Truth About What Makes Us Well. Dr. David Katz is president of the American College of Lifestyle Medicine. He's the founding director of Yale University's Yale Griffin Prevention Research Center.
  
  Welcome, Dr. Katz. Thanks for being on the show.
  
  DR. KATZ: Thank you, Leigh. Great to be with you.
  
  DR. LEIGH: So, this is fascinating because – and maybe go back in history, people were dying of infectious diseases at 30. So, now we're living a little longer. This chronic disease issue-- is it that we are living longer and the body is wearing down? Or is it we are wearing down our bodies? What is the actual percentage that you can contribute to lifestyle that contributes to chronic diseases we see today?
  
  DR. KATZ: At least 80 percent of the chronic disease burden in the world. So, the answer to those questions – and they're great questions – is yes to both. We are living longer and eventually body parts do tend to wear down, but the gap between life expectancy and health expectancy keeps widening because we are living longer. We're pretty good with modern medicine and forestalling death, but modern medicine does not confer vitality. Only healthy living can do that. And we're getting more and more chronic disease at ever younger age, as you well know. We have an explosion of Type 2 diabetes even in children. Those kids live to be 80 or 90 or however old they may live to be; they will have had Type 2 diabetes for 70 years. It's a combination of both factors.
  
  The evidence base indicating that 80 percent of this is preventable with lifestyle is absolutely incontrovertible. I could site many papers, but just quickly, there was a paper in 1993 – 22 years ago – in JAMA, entitled Actual Causes of Death in the United States, and it accounted for all of the premature deaths that occur each year in our country. And fully 80 percent of them were attributable just to three things: what I like to call "bad use of our feet, forks, and our fingers" – lack of physical activity, poor diet, and holding cigarettes in our fingers. In other words, if we don't smoke, are physically active, and eat, more or less optimally, that alone could slash chronic disease risk in a person by nearly 80 percent, and slash chronic disease rates in the world by nearly 80 percent. And if we append just a few more priorities – sleeping enough, managing stress, having strong relationships, good social connections – the figure rises above 80 percent. Study after study after study all around the world shows the same thing.
  
  DR. LEIGH: Yes, it is interesting. Even aside from chronic disease, we're now finding – with smoking aside, because, I guess, obesity is the new cigarette or the new smoking today – but the cancers, even types of cancers...
  
  DR. KATZ: Substantially preventable. And dementia, the new age boogeyman – I mean cancer used the be the scariest word in the medical lexicon, I think it's dementia now as we do expect to live longer – but Alzheimer's, dementia shares risk factors with cardiovascular disease. Cancer is an inflammatory process and shares risk factors with diabetes and cardiovascular disease. So, you do the same things right, and you slash your lifetime risk of all major chronic disease.
  
  To site another study done by CDC scientists in Potsdam, Germany among 23,000 adults, compared those who didn't smoke, ate well, were active, and controlled their weight to those who got all four wrong, and the lifetime differences in all major chronic diseases – heart disease, cancer, stroke, diabetes, dementia – was 80 percent. It was 80 percent less total chronic disease among those who got just those four things right. So really, it's an astounding benefit. [dog barking]
  
  DR. LEIGH: Yes. And I got to laugh a little bit because I have to lock my dog out of the room because if she sees a squirrel, we're done. [laughing]
  
  DR. KATZ: [laughing] They're good for my mental health, having my dogs around, but they're not so great for radio interviews.
  
  In any event, Leigh, the critical thing here, I mean this is all true, but the issue is how do you get there from here? There are a couple of key things. First, we really ought to change the world and make it easier. We live in a hypocritical culture. We wring our hands about epidemics, obesity, and diabetes in our children, but we keep running on Dunkin and marketing multi-colored marshmallows to kids and calling it part of a complete breakfast. Yes, it's the lousy part of a complete breakfast, and we've got to be honest about that.
  
  Then, the other issue is while we're waiting for the world to change, we need to take matters into our own hands. What the book Disease Proof is really about is what I call "skill power." Will power is wanting to get there. But you are a medical expert; you've got a skill set. I'm a preventative medicine specialist; I've got a skill set. We know how to eat well in ways that other people may not. We know how to fit physical activity into a hectic schedule in ways other people may not. Skills can be shared; skills can be acquired. What I decided to do in this book was take the skill set I use every day and spell it all out. Say, "I can do it, you can do it, too." But you can't expect it to just happen. You have to take matters into your own hands.
  
  The skills make getting there from here much easier. If you try to do it just with willpower, it's really hard and eventually your willpower wears out. But if you've got "skill power," it gets much easier. For example, you don't need to give up sweets to address the sweet tooth; with skill power you can identify all the stealth sugar hiding in your diet in foods you never thought were sweet in the first place; get rid of that and there's no heavy lifting and rehabilitate your taste buds in the process.
  
  All of a sudden, you're eating much less sugar, taking in fewer calories, starting to feel better, lose weight, and you never even touched desert. Innumerable examples just like that of how knowledge really is the power to get there from here.
  
  DR. LEIGH: It's so true, and at some point I'll have you back and we can have a show, because there is a disparity in healthcare too with indigent populations, food deserts, and whatever. But it's sad. I've had parents come in and say their kids are overweight. Well, you think yogurt is good for you, but when you look at some of these yogurts –
  
  DR. KATZ: Which yogurts? [laughing]
  
  DR. LEIGH: Right! They're adding all this fructose corn syrup.
  
  DR. KATZ: They aren't healthy. You can have plain yogurt, but if you buy the wrong yogurt it's basically a delivery vehicle for a soda. Absolutely. We can get there from here but we often make assumptions that get in our way. We know what a healthy diet is; we really need to work on practicing it and stop debating it all the time. It's doable; it's a challenge, but it's definitely doable. I'd love to talk further whenever there's a chance. Today my dogs wish everybody and healthy, happy weekend.
  
  DR. LEIGH: [laughing] I know, it is crazy. But I always say, even at McDonald's, you can make some healthy choices: go in, get the chicken plain, maybe don't eat the bread, or if you're getting the salad, don't put on all of the dressing, pour it in the thing and you can use your fork and dip it in for a little taste. So, I totally agree with you, Dr. Katz. It is doable even at these places because no matter how much we say, I don't know that we will ever get rid of the McDonald's or we'll ever get rid of these things.
  
  DR. KATZ: We may not and maybe we don't need to. I think, first of all you're right, we can make little tweaks almost anywhere. Secondly, what masters the food supply is the food demand. When enough of us are making those kinds of adjustments all the time, the retailers like McDonald's will change their offering and change their behavior because they've got one great priority, and that is to succeed in business. And that means keeping the customers satisfied. It's up to us to decide what does keep us satisfied, and if our health and the health of our children is a priority, and we shop accordingly, the food supply can change.
  
  DR. LEIGH: I think some of these chains have done little bits, like adding milk, taking things out but it's a long arduous process. It's very interesting. It's a great book. I like the idea that you can do these little steps because it just seems impossible when you look at it on the whole. So, these little steps. What people don't realize is it's not fun, you may live longer, but it isn't fun when you have a chronic disease and you're really sick with it.
  
  I want to thank my guest, Dr. Katz. The book, again, is called Disease Proof: The Remarkable Truth About What Makes Us Well. Where can you get the book, Dr. Katz? It's on Amazon, I'm sure.
  
  DR. KATZ: It is. All the usual places online and bookstores and you can get more information at my website davidkatzmd.com.
  
  DR. LEIGH: This is the Dr. Leigh Vinocur Show, it's Health from the Outside In, on RadioMD.
• Length (mins): 10
• Waiver Received: No
• Host: Leigh Vinocur, MD