Improving Patient Outcomes Through Prevention: Fitness and the Physician

As physicians, we are all held to a high standard.  It is our responsibility to care for patients and their families.  We must assimilate knowledge and apply it to individual patients and their diseases.  As healthcare costs continue to rise to even higher levels, prevention of disease becomes incredibly important.  As healthcare reform is phased in, more documentation of preventive care counseling is going to be required.  Physicians must ask about smoking, exercise, alcohol use and diet.  Weight control and striving for optimal body weight is critical in prevention of many chronic diseases such as diabetes, heart disease, hypertension, arthritis and sleep apnea.  However, often counseling is not enough–as physicians, we must lead by example.

Physicians who practice fitness in their own lives are much more credible when given advice to patients who may be overweight or deconditioned.  Recently, an article in the Cardiovascular Business addressed the issue of inspiring and motivating patients to make lifestyle changes.  Researchers examined studies on physical fitness, exercise and attitude and created a meta analysis that was presented at an AHA scientific session in New Orleans last month.  The findings were quite profound.  If physicians counseled patients and THEN provided referrals to community support groups or organizations, patients were more likely to effect change and make important lifestyle moves that improved their overall health.  Even more impressive was the fact that the analysis showed that if the physicians who were doing the counseling were more physically fit and DEMONSTRATED a lifestyle with healthy habits, patients were much more likely to “buy in” and change their own lifestyles.  Moreover, 23 observational studies which were included in the analysis, showed that physicians who participated in physical activity and had healthy lifestyles were much more likely to counsel patients in the first place.

As I reported in my blog from February 2012, a study in the journal Obesity, studied over 140,000 physicians and found that overweight physicians were unlikely to bring up weight loss and diet and other important preventative medicine topics during routine office visits.  However, those who regularly exercised and had more optimal body weights were much more likely to discuss these issues.  This particular study received a great deal of press in the New York Times and I believe that there are many lessons from these studies that will benefit both doctor and patient.  First of all, in order to be most effective in treating and counseling our patients, we must strive for better health ourselves.  Although the demands of our jobs often make good nutrition and exercise difficult, MAKE time for fitness.  Share your own personal journey to better health with your patients.  As a healthcare provider, we can inspire our patients and show them the way to better health.  In the US today, we spend more money per person on healthcare and disease than any other industrialized country in the world–as a corollary, the US is the most OBESE country in the world as well.  We can and must make an impact in nutrition and fitness in order to help control costs and prevent disease.  Counseling in the office may not be enough–use community resources to help patients along the path to better fitness.  Referrals to nutritionists, personal trainers, weight loss groups and supportive gyms can make the difference between success and failure.  In particular, learning better nutrition habits may be the critical part of the entire process.  Locate a registered dietician in your area of practice and partner with them.  Consider bringing a nutritionist into the office to see patients a few days a week.

As physicians, we must set the example.  We must strive for better fitness and nutrition and avoid habits such as smoking that can have a profound negative impact on health outcomes.  The key to the future of medicine in prevention.  The key to prevention is proper counseling, follow up and patient referral to appropriate community resources.  Most importantly, physicians must “practice what we preach” and demonstrate a healthy lifestyle to the patients we care for every single day.


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