The American Heart Association recently released a new policy statement in the journal Circulation that strongly recommends to doctors to aggressively address unhealthy lifestyle choices being made by patients. And the position statement emphasized that lifestyle counseling must rival the typical level of discussion and care being offered to patients who already have high blood pressure, high cholesterol, or other heart disease risk factors.
The policy statement originated from the realization that currently, most doctors treat biomarkers – physical indicators of a person’s health – but the doctors are not spending enough time working with patients to change behaviors like smoking, eating an unhealthy diet, and not exercising at all or enough. So getting ahead of the biomarkers to intercept them, before they indicate the presence of disease, is the new approach being recommended.
There may be a few significant impediments to this new recommendation.
The first is the obvious changes occurring in health care, that force doctors to spend less time with the patient, and more time on their computers and on their phones, in an effort to keep pace with new mandated health care policies. With that being said, Medicare does now require that doctors who care for seniors, implement new specific guidelines that require a discussion of “prevention, wellness and lifestyle habits,” during a standard office visit or follow-up care visit. The doctor has to chart the results of the discussion in order to qualify for Medicare reimbursements. So applying this standard to the entire population is certainly reasonable and would seem to have a big payoff for the average patient……except that doctors are often unable to cover time-sensitive discussions in the time allotted to a standard office visit, especially if serious disease is being treated. That may seem counterintuitive since lifestyle habits directly influence disease…..which brings us to the second stumbling block.
Most doctors will tell you that only a small part of the population of patients that they see, want to discuss lifestyle behaviors or their weight. Doctors encounter significant resistance when they try to bring up a discussion about diet, exercise or other lifestyle behaviors. Unfairly, there has been an indictment of doctors if they sense reluctance and avoid the discussion. If they do forge forward and “bring it up,” patients can often times become offended or turned off, and stop coming to their visits for fear of being “cornered.”
Still the policy’s recommendations strongly suggest that a doctor create “inter-professional practices that connect patients with behavior change specialists, like dieticians or psychologists,” to implement the 5 A’s:
Assess a patient's risk behaviors for heart disease.
Advise change, such as weight loss or exercise.
Agree on an action plan.
Assist with treatment.
Arrange for follow-up care.
Of course, somehow reimbursements need to account for the extra time with the patient. Changing a patient’s attitude so that they realize the value and need for these conversations may be incredibly difficult. Time will tell if doctors and patients embrace these changes.
Amy Hendel is a health professional, journalist and host of Food Rescue, Simple Smoothies and What’s for Lunch? Author of Fat Families, Thin Families and The 4 Habits of Healthy Families, she tweets health headlines daily @HealthGal1103. Catch her guest appearances on Marie! on Hallmark and other local and national news and talk shows.
Follow my blogs at: http://www.healthcentral.com/profiles/c/86903
Published On: October 16, 2013