I had a pretty full day at work today and noticed that I felt the most satisfied and useful after a couple of consults which were mostly about preventive health care. I was surprised at myself – that I actually got a kick out of doing this work, which as a medical student, I thought would probably be the most mundane work in general practice.
There are multiple guidelines these days about recommended preventive activities for different age groups in the general practice setting and now that I’ve got my head around these and can see them actually working to improve my patients’ cardiovascular risk profile, I feel comfortable, confident and helpful doing this sort of work. I have also noticed in my time as a GP registrar that most patients are actually quite responsive to questions about ‘SNAP’ (smoking, nutrition, alcohol and physical activity) and appreciate a ‘thorough doctor’ who regularly checks their blood pressure, weight, height and waist circumference, as well as their fasting cholesterol and blood sugar.
It was surprising to me as a student on placement in an Adelaide general practice to see a lady, who had once had hypertension and impaired fasting glucose, manage to ‘cure’ herself of these conditions simply with lifestyle intervention – she had improved her diet and exercised in order to lose weight for her daughter’s wedding, and these ‘illnesses’ had just disappeared – she could stop her blood pressure medications! I was so impressed! Being a healthy weight and having a healthy lifestyle really does make a huge difference, not only to a person’s quality of life and self-esteem, but also to reduce overall cardiovascular risk, namely the risk of heart attacks and strokes.
In my first term as a registrar, I saw a middle-aged man who had been diagnosed with type 2 diabetes 18 months prior. He presented in a very poor state: overweight, hypertensive and with increased lethargy, thirst and urination. He was not taking his diabetes medications and had not been leading a healthy lifestyle. His blood sugar level in the consulting room was around 20, so he and I had a serious discussion about his health (or lack thereof) and what may happen if he continues on his path of denial. We arranged a thorough review and put together a GP management plan with diabetes education and dietician input. Something in him must have clicked. He returned only a few months later a new man. He was taking his medication, had lost 15kg of weight and 15cm off his waist, his diet was much improved, he was regularly exercising and monitoring his blood sugar levels (which had normalised) and he felt so much better! He was my miracle man – this is one of the reasons for the kick I get out of preventive health care in general practice!
As a GP registrar I see a broad cross-section of the population and a surprising trend that I have been noticing is younger people, particularly men, presenting for a ‘check up’. I think this is fantastic! What an opportunity to enquire about these preventive health topics! I take some pride in knowing that all of the separate boxes in the medical software are kept up to date with smoking status, alcohol consumption, family history, social history etc. and take my time ensuring I cover as much as possible in the history whilst this individual is in front of me.
I find that it’s important to enquire a little about the patient’s level of knowledge – their health literacy – and their perceptions about preventive health, especially the risks associated with smoking, drinking, untreated high blood pressure, cholesterol and diabetes, in addition to risks with recreational drugs and unsafe sex. This can serve to open up more dialogue to lead into education about the benefits of preventive care, as well as debugging some common misconceptions.
For instance, there seem to be a lot of people who fall back on the statement, “oh, my blood pressure will be high, it always is at the doctor’s”, as though this doesn’t matter. Even if it is a case of ‘white coat hypertension’, this is not irrelevant, and it is imperative that this is followed up, usually with either a home blood pressure monitor for a week or so, or a 24 hour ambulatory blood pressure monitor.
GPs also need to consider a patient’s social circumstances, including current stressors and financial strains, which can of course impact on a person’s general state of health and wellbeing, including their blood pressure at the time of the consult.
I admit that it is probably quite nerdy that I get a kick out of this stuff, but isn’t that what you would hope your GP would be interested in? Let me know your thoughts!