Lifestyle Counseling In The Doctor’s Office

Obesity.  Stress.  Poor diet.  Sleep deprivation.  Lack of exercise.  Smoking and other dangerous habits.  All these things and more contribute to fatigue, poor health, mood problems and increased risk of heart attacks and cancer.

Why then are doctors so reluctant to tell patients how to address these problems?  You would think our health care system would be on top of helping people eat right, exercise, manage weight, sleep properly, handle stress and do all the other things needed to optimize their health.

The reality, though, couldn’t be farther from the truth.  Lifestyle counseling is sadly lacking in most doctors’ offices.  We’ve got lots of time to talk about drugs and surgery and mammograms and Pap tests and colonoscopies, but not enough time to talk about fiber and sugar and sleep and exercise and community involvement.

This is pretty sad.  It’s estimated that 90% of our health is based on how we live our lives, and only 10% is determined by our genes.  Lifestyle counseling is where the money is, so to speak, in improving the health of our patients.

So why do we miss the boat?  Why don’t more doctors spend more time on helping our patients improve their lifestyle choices?  Why isn’t lifestyle counseling part of every patient visit, in every doctor’s office across the nation?

There are a few reasons.  The first one is time.  In a typical 15-minute appointment, between making a diagnosis and deciding on treatment, many doctors are most comfortable spending the limited time available discussing what tests to get and what medications to prescribe.  They may think that a conversation about what foods to eat and how exercise and sleep may help the patient feel better will take too much time.

Another reason is lack of training.  I admit I’m a few years out from my medical school days but I recall just how little time was spent teaching lifestyle counseling.  When I have medical students rotating in my office I ask them whether they get any training on nutrition and other lifestyle factors.  Generally they agree there isn’t much.

Knowledge about the impact of lifestyle on health is mostly self-taught in the American health care system.  Hopefully that will change as the research about the impact of lifestyle on health is exploding as we speak.  Nutrition, epigenetics (the effect of lifestyle on gene expression), microbiome research on how the bacteria on and in our bodies affect our health, and other studies are coming to help guide us in providing solid lifestyle counseling for our patients.

One more reason that doctors may be reluctant to address lifestyle factors when talking to patients is the feeling that patients don’t want to hear it.  We feel that patients don’t want us to tell them to change their diet or to get out and exercise.  I’m not sure why that is, because most of the time my patients are very receptive to lifestyle counseling.  They may not be ready to act on it, but they do want the information.

Sure, I’ve got patients that make me feel as if I’m beating my head against a wall.  They are happy to take their pills and eat potato chips in front of the TV.  That doesn’t mean I’m not going to sing the praises of beans and a big bowl of salad to them, or not tell them about the benefits of 10,000 steps per day and a smoke-free life.  I figure that if water can create the Grand Canyon, patience and persistence will eventually plant seeds of change in the most stubborn patients.

If you are a person who wants to make healthy lifestyle choices but doesn’t know exactly where to start, ask your doctor for some guidance.  Ask for a dietitian referral or see if they have suggestions on a good book you can read.  Make sure your doctor knows you’re interested not in just taking pills, but in improving your lifestyle as well to be as healthy as possible.

I know that when I have a patient who asks me questions that stump me, it sends me to the literature and textbooks to find the answer.  Who knows?  Your questions may be the reason your doctor begins researching lifestyle factors in disease, starting the education journey that generally doesn’t happen in medical school.  This in turn may help him or her be more effective in helping other patients get and stay healthy.

I may be a doctor, but I’m also a patient.  I want the American health care system to focus on wellness and keeping people healthy, not just waiting until things break down to try to paste it back together again.  We can work together to create wellness, one patient at a time, one doctor at a time.

QUESTION: Do you want your doctor to talk to you about lifestyle choices?

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