Saturday, April 30, 2011
When spouses gain weight and physicians wimp out
A friend of mine is in great physical shape but her husband (We'll call him "Mr. B") has gained 40 pounds since they were married five years ago. He also has familial hypercholesterolemia, and several of his relatives have had heart attacks at young ages. Mrs. B is distraught; she is worried about her husband's health, and has tried to gently nudge him towards healthier eating habits and regular exercise (as well as taking a statin for his cholesterol). Unfortunately, the nudges were received as nagging, and a wedge has formed between them in their relationship.
Last week my friend planned a trip to a primary care physician in the hopes that he would educate Mr. B about the dangers of being overweight and not treating his high cholesterol. "Surely Mr. B will listen to an expert" she thought, "then perhaps he'll realize that he has to change his behavior."
Unfortunately, the primary care physician didn't offer any health counseling to Mr. B. Not only did he not mention that Mr. B should lose weight, but he didn't provide any warnings about the dangers of untreated, very high cholesterol levels. He merely reported that Mr. B's total cholesterol was 300, and that a statin was indicated.
Mrs. B was crestfallen. She was depending on the physician's authoritative input to help her come up with a strategy to steer her husband towards better health. Now Mr. B was left with the impression that things were more-or-less OK, and that his wife's concerns were exaggerated.
Studies have shown that patients are more likely to change their behavior when a physician provides the rationale for it. This power to influence patients is often under-utilized, even though it can save lives. Wives, family members, and loved ones rely on their physicians to have the courage to say things that are difficult to hear. It's our job to do so, even though it pushes us beyond our comfort zone at times.
I wonder how many missed opportunities there have been in my office visits with patients? I know that I don't counsel overweight and obese patients to lose weight at each encounter, nor do I always remember to discuss the barriers to success with them. Sometimes I end up focusing on a patient's chief complaint to the exclusion of their overall wellbeing.
Like smoking cessation, weight loss can be a real challenge. It may require many attempts before long term success is achieved. But we need to keep fighting the good fight and have the courage to speak up and tell our patients the hard truth about their waistlines. I know that there are spouses out there who would really appreciate our help with their own "Mr. B's." As for my friend, I'm going to send her some literature about the risks of obesity and very high cholesterol. Perhaps it's not too late to influence him?
This post by Val Jones, MD, appeared at Get Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
Labels: BMI, cholesterol, guest post, obesity, patient communication, smoking cessation, statins, weight loss
posted by the Better Health network at
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1 Comments:
Hmm. I think the author engaged in some creative writing to make a point. Seems unlikely that a physician (or any person for that matter), would simply state "your cholesterol is high, here is a prescription", and end the conversation. I observe (or receive patient input on) dozen of doctors every year, and never had one walk up to a patient, recommend something without comment, and disappear.
More than likely, the patient heard something that he didn't want to hear, and found the doctor's reason not compelling enough to make him change his lifestyle and begin the med. We all have the tendency to hear what we want to hear. My recent patient with fever and a cough, after given a requisition and an explanation to get an xray, did not. When asked why, stated "it didn't seem that important". Clearly, that's not what I said, or what my actions indicated.
In the case of Mr. B, his nagging wife was more likely disappointed that his physician didn't administer a thorough scolding of Mr. B (a la Dr. Greg House on TV), and instead advised him in a professional way. And if there was any doubt, did Mr. B not have enough concern to look into it himself, with information easily available to the public?
We are dealing with grown up people here, who make serious decisions for their personal lives, their finances, their futures. Are they only children in a doctor's office? Or is Mr. B pretending that he can't put together his wife's and doctor's words, his family history, and the ocean of medical information we all receive daily? I am my patient's professional advisor and advocate, not their parent.
More importantly, this type of self-flagellating article reinforces the ongoing trend of blaming physicians for bad patient outcomes, marginalizing patient responsibility (despite evidence of widespread noncompliance), and justifying the intrusion of third parties in physician patient relationships. We now have a broad range of "doctor-poseurs" moving in, from homeopaths to government agencies to insurer quality ratings to for-profit entrepreneurs, claiming improvements (with no evidence of such), but mostly just siphoning off scarce health care funds.
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