Provocative findings from a new University of Michigan study suggest that younger, newer physicians may be even less helpful as patient counselors than their more experienced colleagues.
The implication for patients is to be more directive with most younger physicians than with older ones. We’ll see what that means in a minute.
Reported in the journal Preventive Cardiology and summarized in HealthLeaders Media, the University of Michigan study by Michael Howe and colleagues looks at doctors who treat patients with coronary heart disease at one of the country’s leading academic medical centers–physicians who should be at the top of their field.
Barely two-thirds of established physicians and one-third of physician trainees (that is, residents and fellows) counseled patients about a healthy diet. The results were about the same for counseling patients about the benefits of regular exercise. It would be hard to justify counseling fewer than 90 percent of patients about both issues.
Moreover, few of the experienced or newer physicians reported feeling confident in their ability to change patients’ eating and exercise behavior. Interestingly, the greatest confidence in counseling patients was reported by physicians who:
- exercised regularly themselves
- were overweight, which may have made them more empathetic and credible, and
- had obtained training in patient counseling–an area that most physicians scrupulously avoid.
Previously, I would have been naive enough to believe that younger physicians are alert to their role as patient counselors. This is the core of the physician role in disease prevention, and preventing disease gets more and more attention all the time. To me, this study is depressing.
When your physician is young, it’s a good idea to:
- Ask your questions, no matter how trivial or obvious they may seem to you (examples: What can I do to get better results in my lab tests? What do these results mean for my health, quality of life, and longevity? My job requires me to sit most of the day–is that okay?)
- Challenge the answers (examples: How can I get more exercise when I don’t have enough time? Do you really expect me to change the way I’ve been eating for 60 years? If we just wait and see what the next test shows, why would we expect it to show anything different?)
- Make sure you understand the doctor’s instructions, because they may be especially unclear (examples: Do I take the pill before or after meals? Does it matter if I get 20 minutes of exercise six times a week, or 40 minutes of exercise three times a week? What do I do if I follow the instructions, nothing seems to change, and I get frustrated?).
Section 1 of our book–one of the parts available for free on this site–offers more suggestions for framing questions for the doctor. That’s the section titled “Presenting a Problem to a Physician.”
More broadly, these study results–although it’s only one study, and others could yield very different findings–point to the need for physician educators, examiners, and regulators to encourage medical students, residents, fellows, and new practitioners to take their role as counselors seriously. Why are they becoming physicians, if not to help patients?