Monday, July 23, 2007

Wellness - Physician Wellness Strategies: Scold, Scare, or Coax?

Tone makes a difference. Employees don’t want to feel scolded about their health.

Kelly Holden, “Wellness Programs Try To Be Welcoming, Too, “ New York Times, July 22, 2007

When I ponder how doctors might coax patients to adopt healthy life styles, my father comes to mind. When my brother, sister, and I refused to eat our spinach, he shouted,“ Swallow it! It’s good for you! Daddy knows best!”

I wonder if Dad might have been more effective had he soothingly said, “Listen, kids. You need to take steps to be healthy and live a long life. Spinach contains all the essential minerals and vitamins. Popeye eats it to become strong. Please join me in this effort to make us all stay healthy.”

Would that approach have worked? Put me down as doubtful. When you’re young and healthy, morbidity and mortality don’t enter your mind.

Spinach may have been good for us kids, but I didn’t eat spinach for the next 30 years. My spinach experience led me to thinking, “How do modern physicians bring patients the wellness table? ”

Doctors and patients alike know good habits are good for them, but many patients don’t want to be scolded or lectured about it.

Wellness strategies pose vexing problems, not only for doctors, but for American corporations.

Some corporations shy away from hiring obese job candidates. Others refuse to employ smokers. They even go so far as to test their urine for nicotine. Wellness programs don’t necessarily work well. Being told to eat your spinach may fall upon deaf ears. Fitness coaching, running tracks, fitness centers, reduced health premiums, and preaching that wellness is good for the company sometimes work better.

Corporations themselves don’t need to be persuaded, There are companies out there, such as Abridge, Inc, and C-Secure in Seattle, with software programs have documented beyond doubt that wellness programs have a significant return on investment, often in the 2:1 to 3:1 range.

But what are physicians to do? They aren’t paid to offer wellness counseling. And many patients with illnesses and conditions stemming from over-indulgence and under-activity resent being lectured to. A serious health event – unexpected development of diabetes, a serious heart attack, unremitting hypertension, or morbid obesity requiring bariatric surgery – may bring patients into the fold.

I’m unaware of any broad physician-led strategy that works well across the board. Health counseling and admonitions require individual approaches between doctors and patients. Physician-patient relationships are one-on-one. No approach fits all. Still, I’m interested in hearing how physicians specifically handle non-compliant patients with destructive health habits and preventive counseling in general.

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