Health Scan: Doctors know about lifestyle counselling, but rarely offer it

99% of doctors surveyed say educating their patients is part of their job, 80% say they don't do it due to lack of time.

Jlem smokers1 298 (photo credit: Ariel Jerozolimski)
Jlem smokers1 298
(photo credit: Ariel Jerozolimski)
Israeli doctors believe that part of their job is to nudge patients toward a more healthful lifestyle, better nutrition, exercise and the avoidance of smoking - but new research conducted by the University of Haifa's School of Public Health has found large gaps between this ideal and its implementation. While 99% of the doctors surveyed said educating their patients is part of their job, 80% said they don't do it due to lack of time. Half of the doctors said they don't get paid to educate patients, while 40% found it difficult to integrate lifestyle counseling into clinical practice. "There are some obstacles that prevent doctors from doing what they believe is their job. In the end, a doctor that doesn't have the means, ability or belief that he can actually change his patients' behavior will say he doesn't have time, that he isn't paid to do this, or that it doesn't interest him," explains Iris Dagan, who conducted research among 218 community physicians. According to Dagan, patients see their doctor as an authority figure whose recommendations they would probably accept when it comes to changing health-related behavior. Dagan's research revealed a few reasons why doctors feel more or less confident in their ability to bring about behavioral changes. "If, as part of his education, a doctor were to get training in how to counsel a patient to live a more healthful lifestyle, he would be more able to effect change and more confident in his ability to do so. A doctor who never received proper training and doesn't know how to counsel patients will prefer not to discuss the issue, believing that he is not skilled in this area," explained Dagan. Another reason is doctors' own lifestyles: One who himself exercises, is not overweight, eats properly and doesn't smoke will be more likely to educate his patients than one who doesn't. "There is a difference between treating a specific complaint or illness and counseling patients to live a healthy lifestyle... Health policymakers need to outline and implement new strategies that will advance doctors' status as lifestyle counselors and enable them to give their patients advice on things they believe in," explained Dagan. FLUID POSITION Gynecologists and ultrasound technicians typically ask pregnant women to lie on their backs while they determine whether they have too little (or enough or too much) amniotic fluid in their wombs. Although the position can be very uncomfortable, professionals have insisted that the results would not be accurate if patients were somewhat raised. The results are critical, as too little fluid can result in intervention, including induction of labor. Now the Hebrew-language journal Ob/Gyn Update reports on a study published in Ultrasound Medicine that says women can be comfortable without the scan results being affected. They tested 50 women with normal pregnancies between 30 and 39 weeks and compared the amount of amniotic fluid registered when the women were scanned while lying flat and when sitting with their back on a slant. There was no significant difference in the computed volume of fluid. If you find yourself in this situation, you can now insist that it is fine to lie in a position more comfortable for you. (Bring a copy of this column if they didn't read it themselves.) BLIND TO SMOKING RISK Teenagers fear blindness more than lung cancer or stroke, but nine out of 10 don't know that smoking can rob them of their sight, according to a study of English youth published in the British Journal of Ophthalmology. The findings are based on the responses of 260 clubbers aged 16 to 18, collected in Bournemouth, Winchester, Manchester and Southampton. One in five of the young women were daily smokers, compared with around one in seven of the young men. The teens were asked if they knew about the link between smoking and certain diseases, such as stroke, lung cancer, heart disease and blindness. Deafness, which is not caused by smoking, was also included, in a bid to balance the responses. Awareness that smoking caused lung cancer was high, with 81% of respondents recognizing the link. But the teenagers were not so well informed about the other health consequences of smoking. Just over one in four realized smoking was linked to heart disease, and only 15% knew that smoking could also lead to stroke. Only 5% knew that smoking can also cause blindness, mostly as a result of age-related macular degeneration; the figure was even lower among those who smoked, only 2% of whom recognized the link. But teens were far more frightened of losing their sight than of any other smoking-related disease, giving it an average score of four, compared with three for lung cancer and two for heart disease and stroke. Nine out of 10 of the teens said they would give up at the first sign of blindness, prompting the authors to suggest that public health messages about smoking which are aimed at teens include the risks of blindness. BARKS AND BITES Young children should not be left unsupervised with dogs, according to a recent clinical review in the British Medical Journal (BMJ). British physicians Marina Morgan and John Palmer wrote that dog bites and maulings are a worldwide problem, particularly in children. In the UK alone, each year 250,000 people who have been bitten by dogs reach emergency rooms, and half of all children are reportedly bitten at some time in their lives. At least two British children die from dog bites and mauling in an average year. They suggest that children be taught to treat dogs with respect, avoid direct eye contact, not tease them and not to approach an unfamiliar animal. They also should not play with any dog unless supervised; run or scream in the presence of a dog; pet a dog without first letting it sniff you; or disturb a dog that is eating, sleeping, or caring for puppies. Rachel Besser, a pediatrician and lifelong dog owner, wrote in an accompanying article that many owners don't agree that children can be endangered when left alone with a dog. She recommended mandatory classes for pregnant owners of dogs to teach them about the responsibilities of ownership. Educational programs for children are also needed, she said, adding that vets should advise dog owners about bite prevention.