Spotlight on: Dr. Scott Lear
November 17, 2014
Management of chronic diseases
Virtual chronic disease clinics
Your research is mainly focused on the prevention and management of chronic disease, all to provide and improve health services to patients. How did you pick the study of chronic diseases as a career pursuit?
Dr. Lear began his career with a background in cardiac rehabilitation. He was interested in heart physiology and physical activity to prevent and treat heart disease. This interest soon expanded to other chronic diseases because of commonalities between heart disease and other conditions. For example, smoking not only puts people at risk for heart disease, but it also puts them at risk for cancer and respiratory problems.
“For heart disease or other chronic diseases, you can’t ignore other conditions the patient may have. You can’t ignore their other conditions because it might be their respiratory condition that’s preventing them from exercising, which can be protective for their heart condition. In looking at multiple conditions, we can treat the patient more effectively.”
If you were to run a hospital, what are some areas you would improve upon?
Gaps in holistic patient care are obvious. Floors in hospitals are based on organs or diseases—there is the cardiac ward, nephrology ward, HIV ward, and so on. Our clinics and medical specialities are based on a model which focuses on organs or specific diseases. This is an effective system for acute care conditions, but it is less effective for the treatment of chronic diseases where people may suffer from multiple diseases.
Instead of medical practice revolving around specialties individually, specialties should be combined to provide patient-centred care.
A current example of patient-centred care is the Integrated Care Clinic at St. Paul’s Hospital, which Drs. Levin and Beaulieu run. It accepts patients who have two or more conditions such as cardiac disease, kidney disease, and diabetes. It fosters intercommunication and a deeper understanding of treatment for one disease in relation to the others.
How do you envision your role contributing to ICVHealth?
Most resources in acute hospital settings are used to manage individual acute conditions. This is extremely valuable, but there is less research, skills, and expertise in the prevention of such conditions.
“Outside of the standard evaluation and identification of projects and helping to adjudicate them, my role would also be to advocate for the investigation and the conduct of prevention-targeted research.”
In working with ICVHealth, Dr. Lear ultimately aims to promote further research to help patients stay out of the hospital and to maintain a healthy lifestyle once they have left.
Tell us one potential strategy that you believe will improve cardiovascular care in BC.
There is not one single strategy, but rather multiple factors that would help improve care.
“We know a lot of things that work in terms of preventing heart disease and managing people after heart disease — good medications, lifestyle behaviour changes. What we are just not good at is ensuring access to those types of prevention strategies or supporting people in engaging in them.”
Dr. Lear further articulates that the research needs to be better applied.
“For instance, let’s say we know that with post-MI (myocardial infarction), 80% of patients should be taking an aspirin… why are only 60% taking them? Why can’t we get 80%? If we know that physical activity is beneficial, what can we do to support the population in being physically active?”
Are there any common myths or misconceptions the public should be aware of?
The myth that people’s health rests solely on individual responsibility is problematic. This belief can delay the use of potentially effective strategies to help people make healthier life choices.
Obesity is a risk factor for many diseases including heart diseases, cancer, gallbladder conditions, arthritis, and it is associated with a social stigma. A common perception is that if someone is obese, it is his or her own doing by choosing to be physically inactive or by adopting an unhealthy lifestyle.
“It’s not necessarily that people are choosing the bad choices when there are good choices around, it’s that we need to make the healthy choice much easier than it is right now […] people have a responsibility for making choices, but choices can only be based on options presented to us. If all the choices presented to us are bad, we are going to make bad choices.”
Are there any favourite sports or hobbies you engage in?
Dr. Lear swims four times a week and rides his bike to work to squeeze in some exercise each day!