Doctors aren’t paid to talk

When it comes to counseling patients on health behavior, the doctor lacks faith – and compensation

Counseling of patients by physicians could have an impact on health behaviors, but it rarely happens. Physicians are paid by insurance companies and government health programs to perform tests and procedures, not to talk to patients. The average 15-minute doctor-patient encounter does not leave much time for lectures. Doctors also do not think they are very good at it. According to a survey of 620 physicians, less than half felt competent prescribing weight-loss programs because they believed they had been inadequately trained.

This lack of reimbursement and confidence yields predictable results. Doctors advise only about one-third of their obese patients to lose weight. That proportion rises to about one-half only if the obesity has created some other medical conditions. Physicians offer to help about 1 out of 4 smokers quit.

Doctors also do not have faith that patients will change their habits. Who could blame them? Barely 1 in 10 diabetics follow dietary guidelines limiting saturated fat. About 18 percent of heart-disease patients continue to smoke, which is not much better than the smoking rate for everyone.

A doctor’s pep talk at the end of the visit does not do much. Success requires a joint action plan and a commitment to follow up. In one study, physicians counseled inactive patients to exercise and had a staff member call later to monitor progress. Those patients walked five times more than those who had standard care.

The American Heart Association advises physicians to use this sort of approach to lower the risk of heart disease. The organization reviewed a decade of research to determine what works best. Joint goal-setting, physician feedback and monitoring topped the list. Self-monitoring, such as food diaries, also helps. However, clinical initiatives are employed infrequently because they are time-consuming and insurance companies will not pay for them.