Physicians Lack Confidence to Counsel Patients on Lifestyle

The poor diet and exercise habits of Americans are well chronicled, and will likely continue despite the growing clamor for wellness programs as bloated healthcare costs teeter on the budgetary scale of the country.

A study, "Do Providers' Own Lifestyle Habits Matter?" from the University of Michigan Health System's Department of Internal Medicine and published in Preventive Cardiology, only  adds to the discussion, looking at physicians themselves not only in terms of their own wellness, but how they convey information about exercise and eating to their patients.

The conclusions could give a person indigestion. Young physicians, possibly overwhelmed by their workloads, seem to opt more for fries than veggies on their dinner plates, and are less likely to exercise than older physicians. In addition, many physicians lack confidence in their ability to counsel patients regarding lifestyle concerning exercise and diet.

So while we are spending millions of dollars on wellness programs, doctors lack the confidence to influence their patients about weight or exercise habits.

With an estimated two-thirds of Americans overweight or obese, the "ability of healthcare providers to counsel patients regarding lifestyle factors such as obesity is imperative," the study states.  Key word there: Imperative.

Meanwhile, the issue of physician health is the subject of growing concern throughout the world.  Because of its importance, the American Medical Association is joining the British Medical Association and the Canadian Medical Association in sponsoring an international conference beginning this weekend in Chicago on ways to help physicians achieve a "work-life" balance.

"Striking a balance between caring for patients and maintaining personal health is one of the most difficult tasks physicians face, but it's imperative physicians make their health a priority for themselves and for their patients," AMA President Cecil Wilson, MD, said in a statement.

As researchers at the University of Michigan Health System have found, taking care of their own health and getting that message across to patients has not always been a physician priority, at least in terms of eating and exercise.

"Talking to cardiology fellows, I just find they are not as attuned to healthy lifestyle behaviors, and sometimes they don't get the training they need," says Elizabeth A. Jackson, MD, MPH, a cardiovascular specialist at the University of Michigan Health System and co-author of the study, referring to internists who were studied. "Often they are busy, just grabbing food on the go, and they are young, too. But their lifestyle habits change over time, and health is thought about in a different way, by older physicians."

The study focused on physicians and physician trainees at the University of Michigan Health System regarding their personal lifestyle behaviors. As defined in the survey, physicians were categorized as internists, family practioners, endocrinologists, and cardiologists. Physician trainees included residents from internal medicine, family medicine, and preliminary year interns.

. Among the findings:

• Trainees were more likely to consume fast food and less likely to consume fruits and vegetables than attending physicians.
• Attending physicians were more likely to exercise 4 or more days per week and more than 150 minutes per week.
• Attending physicians were more likely to counsel their patients regarding a healthy diet (70.7%, vs. 36.3%) and have regular exercise, (69.1% vs. 38.2%), compared to trainees.

Generally, however, "few physicians were confident the ability to change patient behaviors," the study states. Only 10.8% of trainees and 17.3% of attending physicians reported "high self efficacy" for changing patients' diet related behaviors, according to the study.

Both trainees and attending physicians reported low levels of fruit and vegetable consumption and relatively "low levels" of exercise. About 9.8% of trainees and 39.5% of attending physicians reported exercising 4 or more days per week
.

If physicians' exercised, however, they were more likely to be engaged in counseling patients. Their own dietary habits did not seem to play a role in how they counseled patients in what to eat.

And here's an interesting twist: While trainees or attending physicians were not confident in their ability to change patients' behaviors, the overweight physicians seemed to do better at it. According to the study, more than 20% of trainees and 27% of attending physicians were overweight.

The study noted that overweight providers were "associated with increased frequency of counseling patients regarding exercise."

Indeed, physicians who are overweight often can be more effective at counseling patients because they know what they are going through, Jackson says.

"If you are trying to go out there to exercise everyday you are going to know what it's like to have barriers, you can understand where they are coming from by relating and understanding," she said.

Previous studies on smoking also showed that physicians who smoked and who considered quitting themselves were more likely to counsel patients on smoking cessation, Jackson noted.

Too often, however, as the study suggests, physicians "don't have the time or training to be effective at counseling patients," Jackson says.  The study noted that 12.7% of trainees and 23.5% of attending physicians "agreed that they had received adequate training in counseling on diet."

Jackson says more work needs to be done to understand the issues underlying physician and payment communication regarding exercise and healthy eating.

"There are a lot of physicians who have similar issues to patients regarding diet and exercise," she says. "We can acknowledge this to patients and recognize that we know it's not easy to change behaviors."