If you ask doctors to describe their ideal outpatient practice, most will say something about a bustling, thriving clinic. Physicians, nurses, and support staff working together in a spirit of harmony while beloved community members happily come and go, receiving benevolent care. It’s a beautiful picture, one that inspires a sense of compassion, selflessness, and gratitude.
There’s only one problem: Most of those beloved patients are sick. If you ask me, a population burdened with chronic disease is more troubling than tranquil.
Do you want to know what my ideal practice looks like? It is empty. It looks this way because patients take personal ownership of their health, eat right, exercise regularly, and avoid harmful substances. They see me when they sprain their ankle or when genetic predispositions rear their heads, but mostly they care for themselves. Maybe I don’t make as much money. Maybe I lose some prestige. But I feel fulfilled knowing I have taught patients how to stay healthy for life. And what is ideal for my patients is ideal for me.
Hospital advertising is rife with messaging such as “Trust Our Experts,” “Put Your Health in Our Hands,” and “Come to Us for All Your Care Needs.” This has none too subtly created the belief among patients that they are dependent on doctors to make them well, forgetting that good health is largely a product of their own behavior. Physician means teacher, and we must take on the responsibility to educate our patients about what they can do to individually lessen disease burden.
Enter preventive medicine, which strives to address chronic disease before it starts. Preventive medicine thinks forward, recognizing that optimizing sleep habits, healthy eating, and physical activity staves off future dementia, diabetes, and obesity.
We can start today to help our patients recognize their potential for good health. Below are five steps you can take to make preventive medicine a focus of your practice. And if you’re already doing it, keep going! Maybe this will give you some fresh ideas.
1) Make the commitment: Decide you are going to make preventive medicine the framework for your practice. It can be hard to fight the inertia of clinical medicine — hear the concern, prescribe the medicine, follow-up, repeat — but with the wealth of evidence and common sense behind healthy lifestyle practices, have faith your efforts will be rewarded.
Preventive medicine might get you out of your rut, too. It’s fun! It’s effective! It makes you feel like the doctor you wanted to be in medical school. And if your situation calls for challenging existing practice patterns, consider this your opportunity to be the “rebel in a white coat.” Choose to be the force that impacts your patients for good.
2) Send the message: Let patients know you’re serious about preventive medicine. Post signs in your clinic, make a patient newsletter, or display educational resources. Some great information for patients and doctors alike can be found at Food Is Medicine and Exercise Is Medicine.
Most EHRs also have built-in patient education on substance use/abuse and healthy sleep patterns. Make these readily available; put stacks of printouts in exam rooms, in the waiting area, and with support staff. The easier they are to access, the more you will use them.
Make healthy living an obvious, intentional part of your clinical encounters. Ask the patient’s permission to discuss lifestyle changes with a phrase such as, “Simple things like diet, exercise, and quitting smoking can have a large impact on a person’s health. Will you allow me to take a few minutes of today’s visit to discuss some changes that might be helpful to you?”
Demonstrate your own commitment to healthy living by hanging pictures of you and your staff exercising. During the catch-up times of the encounter, talk with your patients about wholesome recipes you’ve tried. Share your excitement when new research comes out about healthy living. (“Guess what was just published in the New England Journal!”) Patients will feel that passion and be influenced by it.
3) Make it personal: Everybody wants to know what’s in it for them. Point out specific problems patients face that could be improved by preventive medicine, and know the benefits of change. Ask patients why they want to become healthier and then link it to a lifestyle measure. For example, if the goal is to dance at a daughter’s wedding, make it clear that lowering blood pressure through diet and exercise can help make that happen. If they smoke, help them calculate how much they will save by not buying cigarettes.
A 2022 McKinsey Health Institute survey revealed that 85% of people feel mental and physical health is important. Find out what that means to your patients and how to help them manifest it in their lives.
4) Have a plan: Preventive medicine can intervene in many areas for a patient’s benefit. However, you probably won’t have time to address everything at every visit. In your daily prep, consider patients’ specific needs and decide what to focus on for that encounter.
Maybe tackling every potential change seems like a tall order for your practice. If so, pick one to two areas of emphasis and do those things really well. You may recognize your patient population consists of a lot of smokers; gather your resources and make smoking cessation a focus of your practice for a while. Gather data and monitor your progress. When you feel the time is right, add another focus.
Despite the best plans, appointments don’t always go as expected. Brief interventions can still make a big impact. Have one-minute, five-minute, or 15-minute lifestyle change discussions in your arsenal. For that one-minute intervention, you might ask the golden question, “What is one thing you can do between now and our next appointment to improve your health?” Write it in the chart and follow-up at the next visit. If you have more time, apply some hardcore motivational interviewing.
5) Roll with the punches: Invariably, patients will return for their follow-ups not having met their goals. Continue to support them in their healthy desires. Modify the target or switch gears to a change they feel ready to make. If you have the right kind of relationship with a patient, you might even consider demonstrating your DEVASTATION that he/she didn’t follow through. You don’t have to chew anyone out, but sometimes we let patients off too easy. It’s OK to show how much we care about them and their health in ways that motivate and encourage.
In promoting preventive medicine in your practice, I give you permission to BE CREATIVE! Make it fun! Invite your patients to do a Walk-With-a-Doc program. Challenge your staff to get involved and have a healthy meal bake-off. Put a “Wheel of Health” in your lobby that patients spin for ideas regarding lifestyle change. There is no “best approach” with preventive medicine. What matters is your patients start thinking about what they can do to be healthier. They begin to feel empowered and independent. Then, they begin to make better decisions for themselves.
You can be a resource for your patients! Your passion, knowledge, and devotion are critical aspects of their health journey. Thank you for striving to provide ideal care. Living life in a healthy way is the ideal situation for my patients, and that makes it ideal for me and my practice.
How are you helping patients become the healthiest versions of themselves? Share in the comments.
Dr. Jacob Miller is a family medicine/sports medicine physician in Grand Junction, CO. He is passionate about efficient, portable health care and is the proprietor of the “Medical Miracles” blog.
Image by GoodStudio / Shutterstock
