The inability of our current healthcare system to influence lifestyle changes in significant ways is a real concern. More than one-third of U.S. adults are obese. We should be able to look to doctors for direction and inspiration to eat less, exercise more and pull ourselves out of chronic illness conditions that are primarily lifestyle-induced.
On a recent segment of “Talk of the Nation” (National Public Radio), host Neal Conan addressed how physicians dole out advice to exercise and eat well: the cornerstone of real health. The discussion was revealing and I’d like to share what listeners learned.
The Physician Discussing Weight Loss
Our current healthcare system is designed to provide “sick care” — not “healthcare.” As such, physicians find some real barriers to conversations about healthy-lifestyle weight loss. When they do happen in the office setting, they fail to inspire change.
This is one of the main reasons I left conventional medicine in search of something more valuable for my patients. Day after day, while ordering lab tests and giving out prescriptions for medications to help reverse chronic illness, I felt I was not able to influence them to make changes to get well.
Conan invited onto the program Ranit Mishori, a family physician in Washington, D.C., and assistant professor of family medicine at Georgetown University School of Medicine. Her comments were worth sharing. In reference to the challenge of patient education and the topic of weight loss, she said: “The biggest barrier for me personally would be time. Patients come in for 15 minutes… and you try to cram in a lot of information and a lot of other issues. And having a conversation about how to lose weight, how to exercise — it’s not something that you can do in five minutes.”
Her concern is a real one: something not being addressed by all levels of the healthcare system. Furthermore, many patients are not at all ready to have a conversation about lifestyle and weight loss.
Mishori said: “Some patients are not ready to have their weight even be taken at the beginning of the appointment. So you can’t just say to everybody, well, lose weight, go exercise, goodbye; I’ll see you in three months. You have to assess how ready [and willing] they are, whether they have the resources to even try to make these changes in their lifestyle.”
Currently, this is a delicate question and could be offensive if not posed wisely by the physician. Mishori continued: “I try to assess whether they are ready to make any changes first. I don’t just say lose weight. I try to see if they even perceive it as a problem. So I might say, listen, your blood pressure today is such-and-such. Your weight is such-and-such. Your BMI is such-and-such. Do you think it’s a problem? Is this something that you feel that you need to change? And sometimes they say: ‘No. I’m actually happy with how I am, how I look, how I feel. I don’t want to change it.’”
Time To Get Real
I suggest we get past this feeling of weight problems being a delicate subject and make it a matter of fact and necessity in the doctor visit. We are not allowed to legally drive a car unless we have proper registration and auto insurance, wear a seatbelt, and follow the rules of the road. Likewise, we should not be allowed to enter a doctor’s office and get professional help unless we are willing to be honest with what we have created in our health by our actions. By this, I propose that the medical system put accountability controls into the care-delivery system: weight measurements along with other vital signs and frank discussions of dietary, exercise and relationship behaviors. Why? Because our actions and choices with our own personal health indirectly affect others through rising healthcare costs.
We can’t afford to turn a blind eye to a reckless driver any more than we should allow physicians and health educators to avoid patient discussions on nutrition, weight loss and exercise. We could just make it mandatory.
A Lack Of Physician Training
Conan also interviewed a listener, Ruth from Bountiful, Utah, who said: “I’m about 15 to 20 pounds over[weight]… I have extremely high blood pressure. And my doctor’s been working with this, and he’s also a good friend. And he’ll pull out these pamphlets and hand them to me… and now I’m just so afraid to go back, I won’t even go in to have my blood pressure checked, because I know that it’s high… and I can’t seem to lose weight and I’m embarrassed. So I’ll bump the appointment… I’ll go as long as I can before he absolutely won’t refill my meds because I don’t want him to know that I’m not compliant. A few times ago, he got so upset he said: ‘Well, you’re just committing suicide slowly. I guess that’s just going to be your life choice.’”
Simple observations of this common scenario bring me to an obvious conclusion: Doctors are simply not given the proper training in how to be a coach (or how to hire one for their patients), nor are they reimbursed for such efforts. Yet coaching patients would be far more effective for their health results as well as economically beneficial compared to the current model of prescribing blood tests and prescription drugs.
Socioeconomic Factors For Lifestyle Change
According to Mishori, a poor person is greatly inhibited from being able to implement lifestyle changes. She argues: “A person who is poor, and maybe it’s a woman who works two jobs and has three kids at home and lives in an unsafe neighborhood, she cannot go out and run in her neighborhood. She cannot afford to hire a personal trainer. She cannot buy a gym membership. She may not even have the time, because she works two jobs.”
I agree somewhat that resources are the key, but lack of emotional resources and motivation are far more the cause of this problem than are lack of finances. Nobody needs a personal trainer or gym pass to begin exercising. Everyone has a floor and tennis shoes. The lack of motivation could be due to depressed mood from being in poverty, but I would argue that motivation can rise with proper education by the physician or a designated coach.
Solutions Around The Corner
Also on the program was Eileen O’Grady, a certified nurse practitioner. After 20 years in traditional primary care, handing out fistfuls of prescriptions and really not getting anyone well or to a lower weight, she found a better way. She discovered the coaching world and how to get people to move forward. She said it was different than education: “It’s not a long conversation. Most people can tell you in two sentences why they’re overweight.” O’Grady counsels clients on the phone from all over the country.
I agree with O’Grady that there’s a lot from this coaching world that needs to be incorporated into the curriculum of medical education and nursing programs.
As a family physician with an emphasis in patient coaching, I have found that personal life patterns (dietary, exercise, communication in love relationships) are the keys to reversing disease, not the drugs I prescribe. If I can coach patients in needed lifestyle changes and also order pertinent lab tests, together we can get them off as many synthetic medications as possible and more effectively reverse the disease processes with lifestyle changes, targeted nutrient supplements and hormone balancing. I currently am developing my M.D. coaching model in hopes of opening this type of practice later this year.
To your long-term health and to feeling good,
Michael Cutler, M.D.
Easy Health Options