Lifestyle GP – refocusing on prevention can benefit us all

“Doctor, look – I managed to keep the weight off!” beamed Mr O, as he patted his trim waist and stepped onto the scales. I smiled in anticipation, genuinely warmed by his excitement. When I first met Mr O a few years earlier, he was 37 years old, mainly working night shifts as a security guard, living on burgers and chips and hadn’t been to the gym in over 2 years.

He was markedly ‘obese’ with a BMI of 32. He had a young family, disliked how heavy he had become and was worried about having a heart attack like his father. Over 6 months, he had managed to shift down to a BMI of 26 due to nothing more than good old fashioned exercise and adopting a healthier eating pattern. It was rewarding to see Mr O maintain his weight years later through lifestyle changes as opposed to heading towards A&E with chest pain and an avoidable heart attack.

We know that prevention is better than cure, but how much time do we spend with our patients on the former?

According to WHO, three quarters of all deaths by 2020 will be from chronic disease. People with long-term conditions account for 50% of all GP appointments, 70% of all inpatient bed days and 70% of overall NHS spend. It is clear that we cannot afford to ignore different ways of working with patients to increase their confidence in self care, decision making, and lifestyle change.

As a newly qualified GP, I jumped at the chance to participate in a pilot study with the Department of Health training GPs in foundation level health coaching skills. I was already experiencing the daily frustrations of reviewing patients with chronic diseases from Diabetes to Ischaemic Heart Disease. Everyday lifestyle choices from eating the wrong foods to basic physical inactivity clearly played a major negative role for some of them.

The course prompted a shift in mindset and provided tools such as motivational interviewing skills and ‘coaching conversation frameworks’ to support and empower patients with long term conditions. Mr O was one of my first coaching patients. Taking a less directive approach in his obesity management certainly felt more empowering than the cursory one minute lecture I used to give on ‘eating better and exercising’ at the end of the appointment. He was in the driving seat, coming up with solutions that could work for him, such as swapping burgers for healthier packed lunches and leaving his car at home. The simple coaching question ‘what three changes could you make yourself?’ prompted his own ideas to start off the weight loss. I was able to review any stumbling blocks alongside what worked well each month. I asked Mr O what motivated him to keep the weight off as he stepped off the scale. “It was a lifestyle choice,” he shrugged, “either get fit or die of a heart attack”.

I am not proposing that a ‘model health coaching consultation’ is possible during a routine appointment where you are also juggling acute issues, medication reviews and QOF points. However, what may be possible in daily practice is taking a coaching approach and asking a few specific questions that hold patients accountable for their own health.

As a GP, we can use the advantage of continuity to bring our patients back to spend more time on holistic care and specifically discussing lifestyle interventions. Taking the example of Mr O – he knew where he was ‘going wrong’. Our patients often know the answer regarding what they need to do and could benefit from some help figuring out how to make the changes. It is clear that engaging patients in taking responsibility for their own health leads to long term health benefits which are rewarding for patients and clinicians alike. It’s refreshing to hear more patients ask what types of food they should be eating and avoiding in order to prevent disease and improve their existing conditions. As a GP, I’m keen to educate myself with a solid evidence base, so I can safely point patients in the right direction when it is not always possible to refer them to a dietician or nutritionist.

It is exciting to see the RCGP announce that Physical Activity and Lifestyle is a clinical priority for the next three years. In July 2017, RCGP presented it’s first sold-out Lifestyle Medicine Conference in Bristol. There is certainly an appetite amongst GPs to incorporate lifestyle medicine into clinical practice and anticipation for more conferences like this across the country. We are seeing a rise in social media of Lifestyle Medics sharing their knowledge of food, gaining followers in their thousands from fellow GPs and the public.

I agree that the current model of GP appointments is not set up to fully incorporate a health coaching or functional medicine approach just yet. Nevertheless, I do believe that we can work towards this until longer consultations become a reality. I expect the next generation of GPs will be more equipped to embrace these through changes in the curriculum and training. I hope today’s GPs simply consider pausing more to offer patients a chance to make lifestyle changes before reaching for prescriptions. The possibilities and benefits are limitless.

There appears to be a revolution on the way and one that is long overdue. 

Dr Sumi Baruah, MBBS, BSc, MRCGP, DRCOG, DFSRH, PGCE


Dr Baruah is a portfolio GP in South London and passionate about the future of the healthcare system and primary care. She has a keen interest in efficiency and innovation to sustain and improve general practice. Dr Baruah is a partner, trainer and LMC representative in Greenwich. Dr Baruah has an interest in lifestyle and preventative medicine and is an accredited Health Coach with the European Mentoring and Coaching Council (EMCC). Most recently she was a key stakeholder representative and GP advisor in a successful Public Health bid winning a grant from the British Heart Foundation for development of an innovative system to detect and prevent hypertension through lifestyle changes for Greenwich residents. She is currently collaborating with NHS London’s GP Forward View team as an Education Lead for a GP recruitment project alongside her free lance work as a consultant in the Health Technology sector.

Further reading:

Health Coaching: 

https://www.pcc-cic.org.uk/sites/default/files/articles/attachments/dr_andrew_mcdowell_a_different_way_to_talk_with_patients.pdf 

https://eoeleadership.hee.nhs.uk/Find_out_more_about_health_coaching 

https://www.networks.nhs.uk/nhs-networks/sha-shared-decision-making-and-information-giving/documents/Impact%20of%20health%20coaching%20-%20London%20Deanery.pdf 

Lifestyle medicine:

http://www.rcgp.org.uk/clinical-and-research/our-programmes/clinical-priorities

The British Society of Lifestyle Medicine (BSLM) has been established in 2016, aiming to prevent, improve, manage and treat lifestyle-related conditions with a multidisciplinary society including GPs  https://bslm.org.uk/

A science-based approach to health can be found at ‘Applying Functional Medicine in Clinical Practice’ at http://www.afmcp-uk.org 

3 Comments
  • Marion Brown
    Posted at 09:45h, 21 August Reply

    Thank you Dr Baruah for some real sense! Our society has become so fixated with ‘medicine’ – and this is at our human peril. It is becoming frighteningly apparent that medicines – and harm from medicines ‘taken as prescribed’ – may indeed be causing a lot of harm and long term illnesses.(1)

    The growing problems of more severe Medically Unexplained/Functional symptoms/syndromes are clear evidence of this. It has been remarkable how much coverage this broad ‘speciality’ (MUS) has attracted in 2017 … and that GPs are being trained and encouraged to ‘treat’ patients who acquire a ‘working diagnosis’ of MUS by ‘taking a prognostic approach, whilst remaining agnostic about aetiology’ (2).

    Unfortunately, once serious disruption to physiological homeostasis has been sustained (as found in MUS/functional disorders) the ‘common sense’ natural approaches – that would have likely have been very effective at a preventative stage – are rendered ineffective or, at best, severely compromised, leaving affected patients with ‘poor prognosis’ and long term ill-health.

    Please can we bring back common sense – and put a brake on the inexorable over-medication of the unsuspecting masses?

    (1) http://bjgp.org/content/67/656/99/tab-e-letters#do-no-harm—a-serious-concern
    (2) https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-017-0592-6

  • Fiona French
    Posted at 12:45h, 26 August Reply

    I agree with the views of Dr Baruah and those of Marion Brown. I am indeed one of the patients Marion Brown refers to. Drugged for 40 years by Nitrazepam and a variety of antidepressants, I am now free of drugs but left physically and cognitively disabled as a result of very severe benzodiazepine withdrawal. Nitrazepam was prescribed in 1975 for myoclonic epilepsy and I immediately had a severe reaction which no doctor seemed to notice. I became hyperactive, lost a quarter of my body weight and within two months I had tried to commit suicide. I spent the next 40 years seeing psychiatrists. Having tapered off Nitrazepam, I now know that I have not suffered from depression for decades, it was the side effects of the drug. I no longer have epilepsy and have no idea when that resolved. I spent 40 years seeking solutions to my “depression”. Self-help books, exercise, diet and so on and so forth. I wonder why no doctor was able to work out why I felt so ill. I now know that I have been poisoned by a toxic drug and that this could have been avoided. No doubt I will be a further “burden” on the NHS in old age. Meantime, I have no other diagnosable illnesses apart from the damaging effects of prescription drugs. I am a member of the large and growing online patient support community and there are many other patients with similar experiences to my own, finding their bodies are in a dreadful state after long-term consumption and/or withdrawal from mind-altering prescription drugs. It isn’t enough to ask patients to change their attitudes and behaviours. Doctors must surely question their prescribing habits and whether they really are in the best interest of their patients. Patients who are unable to withdraw from drugs of dependence are likely to face a lifetime of ill-health and it is largely unnecessary.

    http://bjgp.org/content/67/661/363/tab-e-letters#bad-medicine-the-medical-untouchables

  • Alyne Duthie
    Posted at 18:50h, 26 August Reply

    I cannot agree more with Dr Baruah and with the two previous commentators, Marion Brown and Fiona French. It is clear to me that our society has been beguiled into thinking that “popping a pill” will solve all their ills. I would like to suggest that instead of going down the medical route when it comes to mental health that our doctors give far more weight to social prescribing before they even consider resorting to the prescription pad. How much better for the patient than the myriad side effects associated with psychotropic medication and the often worsening long-term outcomes of for example of the SSRIs. We could spare so many from the hellish and intolerable withdrawal symptoms that can arise from coming off drugs like antidepressants and benzodiazepines as I was unfortunate enough to discover for myself. Clearly we have an over reliance on the medical model for treating mental health that doesn’t always serve patients very well. Underlying issues like social isolation aren’t helped by looking for medical answers and while people wait months for psychological therapies we need a more holistic approach to mental health that reduces the harm to patients and eases the burden on hard pressed GPs. Research by the charity Nesta in 2013 suggests doctors are keen to offer the “more than medicine” approach of social prescribing. Of the 2000 people questioned by Nesta only 9% had been offered a social prescription while 55% would have liked the offer of a social prescription. I’d like to hope that social prescribing will become normal practice and less people will become part of our medicated society with the associated harms this can bring.
    http://www.nesta.org.uk/publications/more-medicine-new-services-people-powered-health

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