I found myself laughing the other day when a patient quoted back to me, “Water is my friend.”
I say it several times a day with a bouncy little cadence, “Water is your friend. Water is water–not pop, coffee, or tea. Water is water.”
Whether a patient is sick, well, seeking diet advice, or general well-being, the phrase makes its way into my patient interactions multiple times a day. A very simple concept but so often ignored.
Water is essential
The average person is made up of 55% water–60% in men and 50% in women. While water is found in all tissue, the bulk of the water is found in your lungs, blood, skin, muscles, brain, and bones.
Water is key in:
brain function
lung function
muscle function
bone health
regulating body temperature
maintaining weight
transporting of blood containing oxygen and nutrients to all tissues
How Much should I drink?
We have probably all heard the eight cups of water a day rule. While this is a good rule, you may fall short of your body’s daily needs.
A better estimate as depicted in the graphic to the left takes weight into account. Keep in mind the fitter you are the more water you need as lean tissue contains more water than adipose tissue.
Your activity levels are also going to increase demands on water intake as well. With every 20 minutes of exercise anticipate a minimum of 6 oz of additional water intake.
Thirst is not a good indicator. If you are thirsty you are already behind on your water balance.
Your urine is another tip-off to your hydration status. It should be clear to light yellow.
Why Doesn’t Pop, Coffee, or Tea Count?
Pop(or soda), coffee, and tea are traditionally consumed with caffeine. It is the caffeine that takes them off the list as providing you any hydration. In fact, the caffeine acts as a diuretic and robs your body of essential water. Rule of thumb I tell patients is to consume an extra cup of water for every cup of caffeinated beverage or avoid them altogether.
“Oh, the good old days—the good old days when your doctor was accountable, accessible, and affordable to you.”
Grandpa remembers when Doctor Johnson used to make house calls. He also remembers seeing him at the local baseball fields helping his best friend David with his twisted ankle that hot July summer night after he slid into home plate. Grandpa says when Grandma was having troubles getting her medicines Doctor Johnson called the hometown pharmacy to ensure they got delivered on Saturday. Grandpa doesn’t recall ever having troubles getting in to see Doctor Johnson and certainly doesn’t recall being rushed through a ten minute appointment. He also said if their neighbor Judy couldn’t pay her bills, well good old Doctor Johnson just took care of her. Oh, the good old days—the good old days when your doctor was accountable, accessible, and affordable to you.
Here enters a new model of practice that is sweeping the country for primary care services—Direct Pay Care. Patients forego insurance to cover their preventive care for drastically discounted prices. Doctors spend less time on paperwork, compliance checklists, and coding issues so they can focus on spending time with and taking care of their patients.
Just the other day my six-year-old daughter asked me why I became a doctor. Well, it certainly wasn’t to argue with insurance companies over covering a test I felt was clinically indicated. It wasn’t to document for eight hours of my twelve hour day to justify my care. And it certainly wasn’t to be told whether I was a good doctor or not by a checkbox.
In this day of escalating healthcare costs and regulations, many family physicians are finding themselves turning back to their roots to practice medicine as Doctor Johnson did. Most family physicians went into family medicine because they like taking care of people. Unfortunately with the demands today in our current system, the focus has become less and less about caring for patients.
Accountable
Imagine if your doctor was accountable to only you. Not to insurances nor government—accountable just to you. Some family doctors are doing exactly that and going back to focusing on their patients’ needs without excessive regulatory distractions. By avoiding some of the red tape imposed by insurance and government entities, the doctor becomes more accountable to the patient. It is estimated that the average family doctor spends only one third of his or her time actually with their patients. So what is your doctor doing the other two thirds of the time? He or she is charting, coding, and arguing with insurance companies. Clearly this does not improve your care.
Accessible
Imagine if your doctor was accessible to you. A wise physician mentor once told me no matter how talented or nice I was as a physician, if I wasn’t “accessible” I was no good to my patients. It is commonplace to wait weeks or even months to see your “regular” doctor. It can be challenging to get a nurse to return a phone call let alone a physician. This has become the standard of care that is accepted by patients. This should not be the standard as the physician patient relationship is sacred, and the quality of care suffers because of it. Some family doctors are making themselves accessible by email, open access to charts, same day appointments, and even providing patients their personal cell phone number.
Affordable
Imagine if your doctor was affordable. Direct pay family doctors are back to taking cash for their services at a fraction of the cost of insurance pricing. The average family’s annual health insurance premiums are over $13,000. That cost is shouldered by the employer and the employee and does not reflect co-pays or out of pocket expenses. The standard use of insurance outside of healthcare has been to cover catastrophes. We would never expect our car insurance to pay for an oil change or our house insurance to pay for a new carpet. Our expectation for our health insurance to cover our every day preventive medical care has made health care costs rise exponentially. By eliminating insurance usage at the primary care level, the cost of care and the potential savings to the patient and their employer are staggering.
It has been and is common practice for an employer to pay $500 monthly for an individual’s premium. While the employees don’t see that expense, it does affect them. If the employer were to move to a high deductible plan monthly premiums would drop to under $200. That is $300 in savings for the employer. That money could then be applied to a Health Savings Account that is tax-free money the employee can use for healthcare expenses now or later. In addition, a portion of the savings could also be used to supplement the employee’s salary.
The latest trend in healthcare coverage has been to provide these lower premiums and higher deductible plans combined with health savings accounts. This is a fundamental change that supports the direct pay model. Your dollars are maximized with heavily discounted rates for office visits, labs, and imaging while your remaining money is put into your health savings account rather than lost to insurance premiums.
Accountability, accessibility, and affordability are making a comeback and it is about time. “They just don’t make things like they used to,” said Grandpa. Well Grandpa, many physicians have listened and are trying to do just that with Direct Pay Care.
Whether a patient is sick, well, seeking diet advice, or general well-being, the phrase makes its way into my patient interactions multiple times a day. A very simple concept but so often ignored.
Pop(or soda), coffee, and tea are traditionally consumed with caffeine. It is the caffeine that takes them off the list as providing you any hydration. In fact, the caffeine acts as a diuretic and robs your body of essential water. Rule of thumb I tell patients is to consume an extra cup of water for every cup of caffeinated beverage or avoid them altogether.
Direct Medical Care 
