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Adding another M to the M&M syndrome |
It comes as no surprise to GPs at the coalface of modern healthcare to be told that the Pharmaceutical Benefits Scheme is overspending at a rate that is unsustainable in the long term. We are receiving more and more new guidelines on things such as management of high cholesterol and diabetes, and the bar is forever being raised for more stringent goals. Add to that the ageing population and the burden of lifestyle related diseases such as obesity and diabetes, which are increasing significantly.
The cost of statins and other medications for largely preventable diseases is bound to blow out. Higher taxes are a strategy being advocated by the Australian Pharmaceutical Manufacturers Association to deal with the problem.
Consumer groups are calling for the removal of tax deductions for drug ads for pharmaceutical advertising. The Pharmaceutical Benefits Advisory Committee advocates drug companies be covered by price volume agreements so that cost blowouts can be shared.
Far too little emphasis is being placed on disease prevention, which seems to be left in the too hard basket by health authorities. However Finland has been able to show the world that ischaemic heart disease rates can be significantly reduced, and more recently was the first country in the developed world to show obesity rates levelling off. This is a country that has a far less favourable climate than ours for outdoor activity but still manages to find ways of keeping its population on the move, as well as successfully promoting healthy nutrition.
M&M syndrome
In a previous issue of GPSpeak the term M&M syndrome was coined to highlight the relatively new epidemic of people presenting to their GP with the metabolic syndrome (obesity, hypertension, impaired glucose tolerance, hyperlipidaemia) with the compounding effect of mechanical problems such as sore knees, hips, back (plus or minus arthritis), stress incontinence, sleep apnoea etc., all of which may impair the ability to be physically active.
Motivational problems
The other M is for motivational problems, which also seems to be part of this triad of signs and symptoms. Again GPs are only too well aware of the difficulties these people have in the self motivation needed to be physically active on most days of the week on a long term basis. It is not necessarily the role of GPs to become professional motivators, but it is useful if GPs can help provide their patient with an environment where intrinsic motivation can evolve. This may mean imparting knowledge and ideas, lots of encouragement, as well as dealing with emotional issues if present. Other health professionals such as exercise physiologists and psychologists may need to be engaged and new systems available to GPs through EPC Medicare item numbers may make this engagement more feasible.
For M&M&M syndrome patients a creative approach is needed. They will benefit from knowledge about water aerobics, walking in water, resistance training and Nordic walking, all of which are gentle on weight bearing joints. For someone who has been completely sedentary, small increments of increase in activity levels need to be encouraged. The health benefits are surprisingly good and it is very rewarding for GPs to be able to help these patients in ways other than just writing a quick script. It is clearly also good for the wellbeing of our country and GPs are well placed to make a difference.
Dr Andrew Binns
abinns@gmc.net.au
BSc, MBBS, DRCOG, DA, FACRRM
Andrew Binns has been in general practice in Lismore, New South Wales, since 1979 and is a VMO at the Lismore Base Hospital and St Vincent’s Private Hospital. He was involved in obstetrics and anaesthetics for more than 10 years and was also the medical director for the palliative care unit at St Vincent’s Hospital for 15 years. He still serves on the regional committee for palliative care. Dr Binns is executive director of the Northern Rivers Division of General Practice and the medical editor of GPSpeak, a regional medical magazine. He has a special interest in the GP management of obesity and its metabolic and mechanical complications, as well as the evidence-based health benefits of exercise. He runs GutBusters courses at his surgery.
Dr Binns is Adjunct Professor in the Division of Health and Applied Sciences, Southern Cross University. He has an ongoing commitment to research projects with patients who have the metabolic syndrome as well as mechanical and motivational problems. He is also supporting SCU's increasing role in teaching and research in lifestyle approaches to the management of obesity and related complications.
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