Teach medical students to have a healthy lifestyle, and they are more likely to counsel patients to do the same, according to Erica Frank, M.D., M.P.H., of Emory University, and her colleagues.
The “Healthy Doc-Healthy Patient” project, a study involving 17 medical schools, tracked the history of medical students' attitudes about health and their subsequent counseling behaviors.
Previous studies have shown that doctors tend to preach what they practice; physicians who have healthy personal habits themselves are more likely to encourage their patients to adopt healthy habits as well, Dr. Frank said in an interview.
Dr. Frank, who serves as the education coordinator of Emory University's preventive medicine residency program, and her colleagues initially collected data on 4,501 women physicians in the United States as part of the Women Physicians' Health Study. The study included data from surveys of practicing women physicians aged 30–70 years, and showed a significant association between self-reported healthy habits and self-reported counseling and screening practices (Arch. Family Med. 2000;9:359–67).
In general, primary care physicians and ob.gyns. were more likely to report patient counseling compared with physicians in other specialties. Furthermore, physicians in group practices and those in government offices were more likely to report screening or counseling patients compared with those in hospitals or solo practices.
After adjusting for other personal and professional variables, physicians who reported healthy personal habits were significantly more likely to report counseling patients on issues such as smoking cessation, hormone therapy use, skin cancer self-examination, breast cancer self-examination, and annual influenza vaccination.
“We have seen in every behavior we've studied that if you practice a healthy behavior yourself, you are more likely to encourage it in others,” Dr. Frank said.
Promoting and encouraging those healthy habits before the physicians-to-be enter practice appear to make a difference. This theory was shown in a 4-year national natural history study in 16 medical schools, and in a 4-year curricular and extracurricular intervention project conducted with the medical school class of 2003 at Emory University. The intervention itself included specific courses on the importance of preventive medicine for the students and for their future patients. Lectures included such topics as skin cancer prevention, tobacco and alcohol use, exercise, nutrition, and behavioral science.
“We learned a lot at Emory, including how not to make your medical students mad at you,” Dr. Frank said. An intervention program for students must be sensitive to the needs and desires of the student population, she noted. During follow-up focus groups, the students complained that the questionnaires about their healthy habits—or lack thereof—were too long and repetitive. The surveys took about 30 minutes to complete and were given three times during the 4 years of school.
Extracurricular and optional interventions during the students' years in medical school included healthy-cooking classes, weekly yoga classes, e-mails summarizing prevention-related studies, and personal health prescriptions based on lifestyle reviews with the primary investigator.
Overall, the students were supportive of interventions in which faculty members were involved, such as dinners and activities like hikes or runs. However, students also complained that they were being nagged, despite the investigators' best efforts to convey that their emphasis on student health was to produce better physicians, and not to criticize the students' personal behaviors.
Promoting good health among medical students is “an efficient and powerful way to improve the health of whole populations,” Dr. Frank said. Based on the Emory student surveys, those who engaged in healthy behaviors were more likely to counsel patients about preventive medicine. Data from the 16-school natural history study currently under review also show the degree to which the school encourages students to be healthy increases the likelihood that students would counsel patients about healthy behavior, she said.
Physicians can enhance their credibility to motivate patients to live healthier lives by spending as little as 30 seconds sharing their own health habits, Dr. Frank noted. She conducted a study a few years ago in which patients were shown two videos of a physician talking about healthy behaviors. In one video, the physician mentioned her own health practices, with a bike helmet and apple visible on her desk. In the other video, the physician gave the same talk, but without the helmet and apple, and without the disclosure of personal health habits (Arch. Fam. Med. 2000:9:287–90). Overall, patients who viewed the physician-disclosure video rated that physician as significantly more believable and motivating than did viewers who rated the physician in the nondisclosure video.
But many doctors still balk at talking to patients about such subjects as diet, smoking, and exercise.