09 Aug 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.
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