Should GPs bother asking patients about lifestyle factors?
I was talking with GP registrar extraodinaire, Dr. Gerry Considine recently about how I felt that some of our attempts at preventive health in consultations can seem quite ineffectual for patients – like we are just going through the motions. A few examples included the discussions we have with patients about smoking cessation, good nutrition, safe alcohol intake and regular physical activity. For instance, it is frustrating when people report that they ‘exercise’ regularly at work, getting up and down in their office to go to the photocopier and back. “That doesn’t count!” he exclaimed, and I agree!
Sometimes it can feel like you are bashing your head against a brick wall when talking to patients about these simple lifestyle measures, which are so important for a person’s general health, and yet fall by the wayside for so many of us. It can feel like patients are rolling their eyes and thinking, “here we go again; I already know this”. Yet these brief conversations with our patients can and do have a positive impact on their lives, even if this does not occur immediately. It is immensely important therefore for us GPs to persist in broaching these topics periodically with our patients, even though sometimes it can feel as though this is a fruitless task. It is a duty of care on our part and I think that we underestimate the power that these conversations can have.
I recall that when I was a teenager, I was surprised when my GP enquired about how much exercise I was doing at the time. (On a side note, I am quite sure now that my GP was using the very useful HEADSS psychosocial assessment tool for consultations with adolescents!) This resonated most with me at the time because the truth was, I wasn’t doing as much exercise as I should have been. The simple fact that he enquired about it made me think that he felt it was really important for my health and wellbeing to be doing regular exercise; so I increased my frequency of exercising as a result…(for a time)!
A brief intervention is a time-limited (1-30 minute) conversation between a practitioner and a patient focused on addressing hazardous or harmful behaviours. Brief interventions utilise the stages of behaviour change model, which is part of a broader conceptual framework known as the Transtheoretical Model (Prochaska & DiClemente, 1982; 1986), to help guide interventions appropriate to a person’s readiness to change. It is a truncated version of motivational interviewing.
As the Royal Australian College of General Practitioners states, “there is considerable evidence that for some patients, brief interventions for prevention, even 1 minutes or less, can increase uptake and improve outcomes.” The 5A framework can be a useful cognitive aid for brief interventions in people who smoke or drink at a hazardous level (if you can remember what the 5As stand for, considering that they all start with the same letter!)
Some of you reading this might recognise that the order in which I have placed the lifestyle factors in the beginning of this article fits with the ‘SNAP’ (smoking, nutrition, alcohol, physical activity) framework for GPs to enquire about their patients’ major lifestyle risk factors. Another potentially challenging side of broaching these topics with our patients, however, having touched on patient attitudes, is that we GPs can actually feel hypocritical if we aren’t perfectly adhering to our own advice, even though we know we should! For rural GPs whose lives are much more in the community spotlight, this can be even more challenging, and could potentially discourage a GP from broaching these topics with their patients at all.
“Trust me, I’m a non-smoking, healthy-eating, moderately-drinking, regularly exercising doctor!”
Another GP registrar colleague of mine, the distinguished Dr. Dave Chessor, wrote a blog post not long ago entitled “Never trust a skinny chef…or a sick doctor?”. I started to think more about where the line is drawn between our professional and personal lives as doctors, and how this might influence our effectiveness as GPs giving advice. It does appear that this line is a lot finer or more blurred in a rural setting, as you can’t walk down the street in your country town enjoying a take-away meal without a few prying, suspicious eyes who are less likely to heed your advice the next time you suggest they improve their diet. (I feel that it brings more meaning to the cheeky statement “do as I say, not as a do”!)
At the end of the day, we are all human and we all have our faults and vices. We can only do our utmost as GPs to give the most up-to-date and evidence-based advice on healthy lifestyles as we can. It is then up to the patient to make changes as they are ready. We never know which piece of advice might just happen to hit home for a particular patient at a particular time in their lives; it is our duty to keep trying! The answer to my initial question is, therefore, “of course!”