October 8, 2013
News Review From Harvard Medical School -- Doctors Pushed to Treat Unhealthy Behaviors
Doctors should devote as much attention to people's unhealthy habits as they do to treating the consequences, such as high blood pressure, a new report says. The new policy statement comes from the American Heart Association (AHA). It urges doctors to follow the "five A's" in caring for patients. The first "A" would be to assess people's behaviors that increase their risk of heart disease. Examples might include poor diet, smoking or lack of exercise. Then doctors would advise them to change, such as quitting smoking. Doctor and patient would agree on an action plan. Finally, doctors would assist with treatment and arrange for follow-up care. Part of the plan would be to refer patients to specialists who could help with behavior change. These might include a dietician, a psychologist or a health educator. Insurance plans also would need to change to make sure these services were covered, the AHA said. The journal Circulation published the study. HealthDay News wrote about it October 7.
By Lori Wiviott Tishler, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
The American Heart Association (AHA) has come out with an important position statement that urges health care professionals to aggressively treat unhealthy lifestyles.
The AHA says that medical teams should follow the 5 A's:
- Assess factors that increase a patient's risk of heart disease (such as smoking and weight)
- Advise behavior change
- Agree on a plan
- Assist with treatment
- Arrange for follow-up care
The AHA hopes this will help meet its goal of improving Americans' heart and blood vessel health 20% by 2020. A second goal is to decrease risk of death from heart disease and stroke 20% by the same year.
The AHA statement cites excellent data showing that healthy behaviors lead to improved health. It urges the use of health care teams -- from doctors to dieticians to health educators -- to help patients with these important goals. Community and technology-based resources also can play a role.
These goals are admirable. They are unarguable. Healthier lifestyles lead to decreased risk of heart disease and other chronic illnesses. More support in more places can definitely help support this goal. We have proof that it works.
Yet, as a primary care doctor working in our current fragmented system, I'm skeptical. Without question, I agree with the goals and the intent. It's always better to prevent than to have to treat. I'd rather see a young person engaged in exercise than to help that same person at age 60 after a first heart attack. But the devil, as they say, is in the details.
In our current fragmented system, where discussions of health care have currently shut down our federal government, how on earth will we develop teams to coach ordinary citizens on behavior change? If we can't ensure funding for supplemental nutrition, how can we ask people to eat better? If we can't support mental health care, how do we help people feel good enough about their lives to want to be healthy?
I think of my own urban primary-care practice. I'm so proud of the hard work of the doctors and staff. I would dearly love to have a health coach, a nutritionist and a psychologist at the ready to work with my at-risk patients. But, even in our incredibly progressive state, with progressive and well-intended hospital leadership, I can't pay them. Even if I could, I couldn't find a place for them to sit in our overcrowded space.
The call to action does not ignore these facts. But I do think it far underestimates the challenges of real, meaningful transformation toward a system based on caring for the health of people and not just for their illnesses.
What Changes Can I Make Now?
For your health, right now, you can remember the admirable goals of this article. People who lead an active lifestyle, eat well, exercise and take care of themselves are healthier.
It's not rocket science, but it does require real commitment to self-care. Talk with your doctor about setting some goals for yourself to be healthier. One step (perhaps literally) at a time will go a long way toward health. Pick one thing and give it a try. You might be surprised at how far it takes you!
For your community, start thinking about what matters to you. I encourage you to begin discussions with your family, friends, neighbors, coworkers and legislators about how you want to spend your health care dollars. Also, think about how you want to use your influence and your tax dollars to help people who don't have the same access to health care, safety and education as you.
What Can I Expect Looking to the Future?
I hope that the future brings lots of what is proposed in the AHA's call to action. I hope that our country, its people and our workplaces engage in really creative thinking about how to create, support and sustain these wonderful initiatives.