March 15th, 2019
The Lown Institute and American Family Physician are collaborating on a new series of commentary articles called the “Lown Right Care” series. This series applies the framework of right care — evidence-based, patient-focused, high value care — to common clinical situations. Each article provides an example of a common clinical situation where there there are opportunities to avoid overuse by not doing things, and to improve underuse by incorporating things into routine practice.
In the newest edition in the series, Dr. Ann Lindsay, Dr. Ajay Sharma, and Dr. Alan Glaseroff tackle a tough issue in primary care — how to help patients make lifestyle changes to improve their health. Most primary care clinicians have been in a situation where they attempt to provoke a patient to make lifestyle changes, such as stopping smoking, exercising more, or losing weight, but to no avail. On the other hand, many patients can recall a time when a health care professional barked orders at them without first listening to them.
For conditions like mild hypertension, that depend a lot on patient behavior outside the clinic, adherence rates are typically very low, write Lindsay et al. This can be frustrating to many doctors; why wouldn’t a patient want to do whatever is necessary to be healthy? What doctors may not consider is there are often parts of a patients’ history, goals, and beliefs that affect how they think about certain interventions.
So what can primary care doctors do to engage patients and make it more likely they will engage in healthy behaviors? Lindsay et al. list several steps to effective communication that even the busiest clinician should be able to do, including: Emphasizing patient ownership over their health goals, partnering with patients on what they are willing and able to do, taking small steps rather than large leaps, scheduling follow-up visits to check in, and — most importantly — listening to the patient and showing caring.