Fresno, California, the largest city in the Central Valley, is surrounded by agricultural land and burdened by the highest rates of chronic illness in the state. Obesity, hypertension, and diabetes are robbing residents of their health at an alarming rate, says Hector Ramos, M.D., a primary care physician at Saint Agnes Medical Foundation in Fresno.
“The only way to combat these epidemics is by people making lifestyle changes," he says. “But it doesn't translate to anything if all I do is tell patients to exercise more."
Real change comes over time, says Ramos, through enduring doctor-patient relationships. So Saint Agnes, a high performer on the athenahealth network in quality measures for chronic and preventive care, is moving healthcare beyond the exam room and into the community.
Inviting patients on a walk, for example.
One Saturday morning last June, Ramos traded in his white coat for sneakers and headed to a local park, where he met a dozen or so of his patients. After giving a short talk, he led the group — from a parent pushing a child in a stroller to an 85-year-old using a walker — on a five-mile stroll along the park's paved path.
The distance was definitely challenging for some patients who were very out of shape, Ramos says. But they were willing to give it a try, and eager to have the chance to ask him questions —without being charged a cent.
Hundreds of physicians across the country are making similar connections as part of the Walk with a Doc, a grassroots program launched in 2005 by Dr. David Sabgir, a cardiologist in Columbus, Ohio. Ramos discovered the national initiative through a flier announcing a local walk with another doctor, and was eager to lead his own walk.
The program — as simple as it is — shows encouraging results across its network of 301 chapters in 44 states. Patients who walk with their doctors, according to the organization, report being more active and feeling more educated and empowered to be healthy.
Ramos' whole office turned out to support the event. A physical therapist, a psychiatrist and a neurologist — all wearing Team Ramos T-shirts — were excited to get to know their patients better, and possibly meet new ones. They conducted “curbside consultations," addressing people's individual needs, from basic life skills to in-depth discussions on topics such as stroke prevention.
Many patients brought relatives and Ramos brought his own kids, adding to the morning's convivial, casual atmosphere.
Typically, Ramos spends most of the allotted 15-30 minutes of an office visit going over patients' lab results, cholesterol and sugar levels and medications. This doesn't allow much time for physical activity counseling. Spending those few off-the-clock hours with patients, he says, gave him time to not only discuss ways to get more active, but also to practice it.
And that's another advantage of the program, he says. A patient-centered approach to population health is often based on camaraderie. So many patients are motivated to be more physically active by the fact that their doctor is walking right alongside them — and often, Ramos says, doctors share their struggles to maintain a healthy lifestyle.
“Unfortunately, many physicians aren't taking care of themselves by staying healthy," he says. "This is a great way to keep physicians honest by practicing what they preach."
Since leading a second walk a few months ago, Ramos says, he has seen his patients make real progress toward taking charge of their health. Several elderly patients have been motivated to remain more active. One participant even quit smoking because she couldn't walk very far — and has since lost significant weight.
Ramos appreciates the simplicity of the initiative. “All you need is a few staff members in each office to decide where to do it and then post a flier in the front office," he says.
“The more providers who are enthusiastic about practicing what they preach, the better. This is just the beginning."
Erin Graham is a writer based in Boston.