A New Key to Improving the Health of Patients and of the Whole Population: Physicians Preach What We Practice

Kshamica Nimalasuriya, MD, MPH; Erica Frank, MD, MPH

Disclosures

February 22, 2006

It is well known that the primary causes of morbidity and mortality in the United States are largely attributable to unhealthy personal behaviors: sedentary lifestyles, high-calorie diets, smoking, and excessive alcohol use.[1] However, although the average American makes 3 visits per year to a physician's office,[2] millions of Americans do not obtain the routine screening and health habit counseling recommended by Healthy People 2010 and the US Preventive Services Task Force.[3] This is a lost opportunity, as even a brief message during an office visit can substantially improve patients' health habits.[4,5]

However, there is a new approach to improving this situation, since physicians' personal health habits correspond with the preventive care they offer their patients. Frank and colleagues,[6] in a questionnaire-based study of women physicians, showed that, other than being a primary care doctor, having related healthy habits oneself was the most consistent and significant positive correlation with prevention-related counseling and screening.

Specifically, associations were found between physicians' fat consumption and their likelihood to counsel patients about lowering cholesterol, physicians' receiving flu vaccines and their likelihood to administer them, and physicians' personal use of sunscreen and the likelihood of skin cancer counseling. Significant associations were also found between physicians' personal habits and their likelihood of counseling patients about alcohol, breast self-exams, tobacco, and hormone therapy. Abramson and colleagues,[7] in a mailed survey of primary care physicians (n = 298 in 1998), also found that physicians who perform aerobic exercise regularly are more likely to counsel their patients on the benefits of aerobic exercise.

Physicians with good health behaviors not only tend to counsel more, but they also seem to be more effective. For example, in a study by Frank and colleagues[8] involving 130 patients who were instructed to watch a 2-minute diet and exercise video, those who were randomized to the group that heard an extra 30 seconds of content about the doctor's own healthy exercise and dietary habits found the physician to be more believable and motivating. Similarly, Hash and colleagues[9] found that patients (N = 226) of nonobese vs obese physicians were more receptive to counseling regarding treatment of illness (P = .038) and health advice (P = .049).

Furthermore, some physicians believe that they should be concerned about the effect of their weight on their clinical practices: Loomis and colleagues[10] found that 83% of the military family physicians they surveyed (N = 214) felt they should be role models for obesity prevention.

Because of these clinical implications, it is especially good news that physicians tend to have very good health behaviors and outcomes.[11,12,13,14] The Women Physicians' Health Study[15] showed that women physicians' health behaviors, unlike those of women in the general population, exceeded US goals in all examined behaviors and screening habits. Additionally, the women physicians often had better habits than a subset of all women of high socioeconomic status. Likewise, Carpenter and colleagues,[16] in a 30-year cohort of 20,526 physicians from England and Wales, found low mortality rates for cardiovascular disease, lung cancer, and other diseases related to smoking and diabetes. Furthermore, a study of nearly 4 million US men from the National Occupational Mortality Surveillance 1984-1995 database found that male physicians lived longer (average age at death for white male physicians = 73 years, for black male physicians = 69) than did lawyers (72 and 62 years, respectively), all professionals (71 and 65 years), and men in the general population (70 and 64 years).[17]

To summarize, the more physicians practice good health habits ourselves, the more likely we are to counsel patients to do likewise. And if we disclose our healthy habits to our patients, we are even more effective in helping patients make lifestyle changes. Physicians should therefore be especially encouraged to have more healthy personal habits -- this could not only improve the health of physicians, but also be an extraordinarily efficient way to improve the health of all their patients.

Such improvement in health habits may be accomplished by incorporating more emphasis on personal health habits in medical school curricula, in residency training, in practice environments, and in continuing medical education. Furthermore, this personal-clinical link should also be explored in other health professionals. For now, physicians at all stages of training and practice should be particularly encouraged to have healthy behaviors, since this helps our patients and even the whole population to make healthier decisions in their own lives.

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