Physicians don’t get paid to counsel patients, with predictable results

Counseling of patients by physicians can have an impact on health behaviors, but it happens infrequently. The average 15-minute doctor-patient encounter does not leave much time for discussion. Doctors also do not think they are very good at it. According to a survey, less than half felt competent prescribing specific diet regimens because they believed they had been inadequately trained.

The lack of reimbursement by insurers for weight-loss counseling and confidence yields predictable results. Only about one-third of obese patients are advised by their doctors 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 with tobacco-cessation strategies.

Doctors also lack 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 overall smoking rate.

A doctor’s pep talk at the end of the visit does not accomplish 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 two weeks later to monitor progress. Those patients walked five times more than those who were not counseled and monitored.

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 generally will not pay for them.

It does not help matters that Americans are in denial about their health. In a poll by The Atlantic, 9 out of 10 Americans said they were in “very good” or “somewhat good” health. Only 1 percent said they were unsure about their health status.

Yet more than 1 out of 3 Americans are obese, and about 1 out of 10 have a chronic condition such as high blood pressure or diabetes.

Baby boomers are in worse health than their parents were at the same age. They are more obese; have more diabetes, high blood pressure and high cholesterol; get less exercise; and are more likely to use a cane or walker.

A 2009 poll of 2,000 Americans by GE Healthcare, the Cleveland Clinic and Ochsner Health System captured the gap between belief and reality. More than half the respondents said the population’s health “was going in the wrong direction,” compared with 17 percent who characterized their own health that way.

Only one-quarter to one-third knew their personal basic health numbers – body-mass index, blood pressure, cholesterol, blood glucose level – yet the majority said keeping those numbers in a good range was important to good health.

About 95 percent said regular physician checkups were important, but 70 percent admitted avoiding their doctors by hoping health problems would go away or asking a friend for medical advice.

Pollsters asked respondents to grade their health behaviors, and asked doctors to do the same for their patients. One out of three gave themselves an “A” for nutrition, exercise and personal health management. More than 90 percent graded patients “C” or worse on these.