Health Central Park medical director led by respect for elders

Older patients have more control than ever before.

There is one of those good-bad news jokes lurking in a discussion of medical care for older people: The good news is that people seem to be living longer. The bad news is that people are living longer; meaning they are living long enough to develop a variety of health ailments, sometimes needing multiple specialists. Fortunately, there is a special class of primary care physicians - gerontologists - who are able to help older patients by working hand-in-hand with the medical team to give them a stronger voice in the care they receive.

Meet Venkatesh Nagalapadi, MD, the medical director for Health Central Park, in Winter Garden, part of the Orlando Health system, and several other skilled nursing facilities. Nagalapadi is a board-certified gerontologist, who has been practicing with Orlando Health for 15 years.

"In the past," he said, "there was never any patient input in the outcomes they received. That has all changed now."

Until recently, said Nagalapadi, medical care was built around tests and protocols for treatment without much attention to the actual benefit the patient received. Now, the focus has changed to emphasize quality and outcomes. This is true throughout medicine, and it is especially true in geriatric care. This focus on outcomes is achieving improvements in patient longevity, according to Nagalapadi.

"I am seeing more functional, independent 90-year-olds than 15 years ago," Nagalapadi, who is also an attending physician, said. "I am also seeing patients when they are sicker." In general, people are living longer, healthier lives because they are receiving better care and advice on healthy living, said Nagalapadi. But sometimes patients are sicker because they have multiple health problems that have gone undiagnosed and untreated. For example, a 75-year old with diabetes may have had the condition for years, leaving him or her with several ailments, such as nerve pain and kidney disease, that now must also be treated.

And sometimes Nagalapadi sees patients after they have been transferred to a skilled nursing facility to recover following treatment in a hospital for serious ailments. In the past, those patients might have had longer and more expensive stays in the hospital without necessarily receiving better treatment, but the focus on outcomes has changed that.

Dr. Nagalapadi grew up in India in a family of engineers. His father had two doctorate degrees in engineering and his brothers and several other family members were all engineers of one sort or another. "My decision to go into medicine was viewed as an act of rebellion," he joked.

Medicine captured his imagination, and his grandmothers played important roles in his upbringing. He discovered that he enjoyed being with older people. They were interesting, and he cared about them and the health challenges they were experiencing.

After studying medicine in India and Britain, Nagalapadi served his residency at the University of Arkansas in Little Rock, followed by a fellowship in geriatric medicine at the Donald W Reynolds Center for Aging at the University of Arkansas from 2003 to 2004.

At Health Central Park and the other skilled nursing facilities he directs, Nagalapadi emphasizes patient involvement and better management techniques, such as electronic medical record systems that ensure every member of the medical team has the most current patient records.

While the management technology is very important - and something that many smaller practices are unable to afford - the most important element is still with the patient, and ensuring the patient has a clear understanding of their own health.

"I have a saying that I tell my patients," Nagalapadi said. "The eye cannot see what the mind does not know." In other words, patients must understand what is happening with their bodies, so they can help the medical team identify conditions that might require treatment earlier. "Having patient involvement is the key to better health outcomes."

Patients also need to be candid with their doctors not only about their physical health, but their financial health. "Medicare does not pay for everything, and many patients are on fixed incomes of $1,200 to $1,800 per month. If their doctor prescribes a medicine that costs $400 per month or more, they may just not take it." If they don't take their medicines - and don't tell their doctor - the patient's care will suffer. So, it is very important to have honest conversations with doctors about whether they can afford the medicine the doctor is prescribing.

"It is not about limiting healthcare," Nagalapadi said, "but controlling it. The key to being able to do this is by taking ownership of your problem. And we are now better positioned to help patients do that than ever before."