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Doctors hesitant to talk to patients about the need to change unhealthful habits

Apparently, our doctors don’t like to talk with us. At least, not about our unhealthy lifestyles.

Yet, as noted in a commentary this month in the Journal of the American Medical Association (JAMA), the leading causes of death in the United States are related to lifestyle — particularly smoking, eating unhealthful foods, not exercising and drinking too much alcohol.

Many of us —no, probably, most of us — don’t want to hear that we have to give up our nicotine habit, get moving (literally), stop eating so much junk food (yes, even the “all natural” Trader Joe’s kind of junk food) and cut back on our booze. Such patient resistance can be a “frustrating and difficult” challenge to doctors, acknowledges the JAMA commentary’s authors, Dr. Liana Lianov of the University of California Davis and Dr. Mark Johnson of the Jefferson County (Colorado) Department of Health and Environment (and president of the American College of Preventive Medicine).

But that doesn’t let our doctors off the hook. “Physicians cannot ascribe the entire responsibility for inadequate lifestyle changes to their patients, and clinicians must accept some responsibility for deficiencies in the quality of health care,” write Lianov and Johnson. “Merely encouraging patients at the end of an office visit to attempt such changes” is not enough, they add.

Lifestyle changes are considered the first line of therapy for many chronic diseases, such as type 2 diabetes and high blood pressure, yet “physicians often do not follow these recommendations,” write Lianov and Johnson. “For instance, obese patients are advised to lose weight only 36% of the time during regular examinations, a proportion that improves only slightly to 52% if a patient already has obesity-related comorbidities [such as high blood pressure]. Furthermore, only 28% of smokers reported that health care professionals had offered them assistance to quit smoking in the past year.”

Part of the problem, the commentary’s authors point out, is that physicians lack the confidence and knowledge to counsel patients about lifestyle changes. (Which makes you wonder: What’s going on in medical schools?) A survey of 620 family physicians found that only 49 percent said they felt competent recommending weight loss programs to obese patients.

The JAMA commentary accompanies a list of suggested competencies in lifestyle medicine for primary care physicians. The list was recently developed by a blue-ribbon panel of preventive medicine specialists. The competencies all sound great — on paper, at least.  One of the competencies, for example, calls for physicians to  “collaborate with patients and their families to develop evidence-based, achievable, specific, written action plans such as lifestyle prescriptions.”

Call me a skeptic, but my first thought was this: Doctors — and patients — had better learn how to talk and write fast. After all, the mean length of time for the typical visit to a primary care physician is only 20 minutes.

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Comments (1)

  1. Submitted by Bernice Vetsch on 07/19/2010 - 12:40 pm.

    The time allowed for a patient/doctor visit is determined by the patient’s insurance company. Many times, the length may not exceed 15 minutes.
    This has to be frustrating for doctors who want time to discuss such issues with their patients.

    How about a health plan that stresses both the prevention of disease and the development of good health instead of one (run by the insurance industry) that penalizes doctors and patients for doing it right?

    How about the Minnesota Health Plan — which would save money for the state, doctors, hospitals and patients while assuring that NO Minnesotan goes without access to quality on-going care, the kind good doctors want to provide?

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