Quote: “The best physician is also a philosopher” – Galen (Claudius Galenus)
Reflection is key! What can I do better and why am I doing it in the first place? Harness failures as the great teachers that they are and constantly improve.
Why this person is important:
Roman and Greek Physician, Surgeon, and Philosopher (129-216 AD, 87 years). Used anatomy based care (from observing the corpses of dead gladiators) and this allowed him to outperform his piers.
Bags the Question: What are we not using right now in medical practice that will be obvious to future doctors that we should be using?
- I think about bedside ultrasound in this light
-I also think about capturing more exam data through photos, sound clips, and videos and then harnessing new technology and big data insights to learn things not previously known
- photos, sound clips, and videos have so much more data than a written physical exam in a note.
Philosophy Take: Asking the right questions is the key
In a changing world, answers, like epidemiology, are always changing. So in some ways all we will ever have are questions.
The Longevity Physician
We are going to talk about medical providers and physicians in this discussion. But the ideas may be useful for multiple other disciplines within healthcare. Everything from coaches, to personal trainers, physical therapists, pharmacists, etc. There is plenty of room for everyone in longevity and it will take a village to solve aging.
Burn-Out in Primary Care
- In residency, I gravitated toward acute care and hospital medicine because it works tremendously well. I continue to work as a hospitalist.
- After residency, I started an innovative primary care clinic model to address the discrepancy between outcomes of the inpatient vs the outpatient setting
- In primary I was always putting out fires. Additional patients generally get worse over time in spite of best efforts, and the demands are enormous (exceptions exist).
- Lack of autonomy, long work hours, poor data collection and records systems, loss of control, and loss of income (relative to inflation) have all contributed to burnout
- But, I believe the biggest cause of burnout in primary care is its failure to improve health in the developed world. People are getting sicker and at younger ages
- It sucks to fail, It sucks to loose. When demanding patients keep coming back a little sicker, a little more entitled, on a few more medications each time, and more likely to have a sentinel health event (stroke or heart attack) each week, it just sucks.
- I think new models of care are desperately needed in outpatient medicine.
The answer I propose – The Longevity Physician
Longevity Physician Cornerstones
- Focus on patients over the entire span of there lifetime. Heavy emphasis on what patient want out of their life and the long game (goals, wishes, purpose)
- Ultra-prevention focused. Longevity Medicine is the logical progression from the best outpatient specialty ever created, preventative and lifestyle medicine. Let's start squashing chronic disease decades before it occurs.
- Very open minded. But grounded in evidence and willing to change as evidence changes. In 2024, Longevity Medicine should start with lifestyle medicine, full stop
- Technology focused. Use of data, validated diagnostics, and new exciting technologies like deep learning to drive innovation in medicine. New diagnostics, labs, and therapeutics should be experimented with in appropriately monitored settings. But a good Longevity Physician should know what things are validated and what things are experimental and this should be clear to patients.
- Looking toward future therapies that will target aging directly
- Should be seeking standards as a specialty to make care continuous and seemless across providers.
How to get into Longevity Medicine
- start with a strong background in conventional medical practice. Keep your day job and acquire knowledge on the side. My hospital practice and outpatient primary care clinic have aided my training in longevity tremendously. Access to patients, old and young is key. This is the point of residency. It will also aid you in your longevity journey. Just keep doing your day job, but integrate preventative medicine and longevity into it.
- make preventative and lifestyle medicine a focus
- read books (cited below) and journal articles, listen to podcasts, and follow popular media in longevity. I spent 4 years after graduating residency diving head first into all of this. Your patients interested in these topics will challenge you tremendously if you are working in an area of innovation.
- attend conferences in Longevity. Dublin Longevity and ARDD were tremendously informative for me.
- study validated and fringe areas of medicine that relate to longevity. Occupational medicine, geriatrics, immunology, physical medicine and rehabilitation, cardiology, oncology, environmental medicine, and functional medicine have all aided in my understanding of longevity medicine/science. Cast a broad net. Knowledge acquisition will pay huge dividends over time…..as it always does.
- make epidemiology your bed-rock. Know what kills people, destroys their health, and why.
Advice for Patients Looking into Longevity Medicine Physicians
- Any good longevity physician should be focussed on lifestyle factors first in 2024, full stop
- Learn as much as you can about longevity, this will make you a better consumer and maximize the time you have with your doctor – read books, journals, follow media in the space, etc. But don’t anchor to hard on what you find out. A lot of longevity content is or will be wrong in the future.
- Be wary of all the snake oil…..below are my red flags
Red Flags that Should Cause a Patient to Run from a Longevity Clinic or Physician
- lack of monitoring or monitoring that stops after the credit card is swiped
- supplements (especially supplement subscriptions) as the primary means of life extension.
- growth hormone use(most all research supports that growth hormone shortens life) outside of a clinic trial.
- huge promises, huge bills (we are talking 20 -100K per year), and poor delivery
Billionaires are the new model organisms (I would include millionaires as well now)
- Brian Kennedy and many others
- just make sure your outcomes are being monitored and studies so others can benefit from your sacrifice.
There are a lot of innovative longevity clinics out their right now. Many will fail. Some are snake oil masquerading as innovation. But, some will succeed and likely change the paradigm of healthcare in the outpatient setting. Hats off to everyone in the game!
Resources For Longevity Medicine
- American College of Preventative Medicine. Consider a course or training program in preventative medicine https://www.acpm.org/about-acpm/
- Attend Longevity Conferences – So many popping up these days. Wish more offered CME
- Dublin Longevity Summit. https://longevitysummitdublin.com/
- Journal Articles. So many great papers
- Look up the speakers at these and other longevity conference and read their papers
- Podcasts
- Huberman Lab Podcast. https://www.hubermanlab.com/
- The Drive. Peter Attia. https://peterattiamd.com/podcast/
- Many More Great Podcasts
- So many books. Two that I found very helpful as a starting point were
- John Ross, MD. The Longevity Bible. An Evidence-Based, No-Bullshit Guide to Living as Long as Possible.
- Luigi Fontana, MD PhD. The Path to Longevity. How to Reach 100 with the Health and Stamina of a 40 Year Old
- So many more good resources. But these are good places to start
Next Episodes (also light on research, data coming, I promise)
- Review of the Dublin Longevity Summit and Aging Research and Drug Discovery
- Your Longevity Report CardÓ
References
- more data rich episodes to come, I promise!
Thanks again,
Bill Brandenburg, MD
Artists interpretation of Galen's depiction of anatomy
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