Teaching Doctors to Teach Patients About Lifestyle

From The New York Times:

To what extent does lifestyle cause or contribute to disease and disability? And what exactly is a healthy lifestyle anyway? There is much confusion about what type of diet or exercise is best, not to mention how much sleep, stress or sex is ideal. Nor is it clear how best to motivate people to change their habits.

This lack of clarity has inspired a growing movement to inform health professionals and patients about the importance of lifestyle in preventing and treating disease. Its aims are to disseminate scientific research about what it means to live well and to encourage doctors and other providers to incorporate this knowledge into their practices.

Two years ago, a group of doctors founded an organization with the goal of making lifestyle medicine a credentialed clinical specialty and a part of basic medical training. Symptomatically treating disease without assessing patients’ lifestyles or offering them guidance on how to change is “irresponsible and bordering on neglect..."

Still, he acknowledges that there are significant obstacles, because lifestyle counseling is time-consuming and is seldom compensated by Medicare or health insurers.

Reimbursement is a chief concern of the American College of Lifestyle Medicine. The group plans to lobby Congress to that end. And it wants Congress to require that patients be informed about the relative effectiveness of lifestyle changes before receiving certain medications — including blood pressure, acid reflux and cholesterol drugs — and before undergoing procedures like back surgery, bypass surgery and stent placement.

But first, Dr. Kelly said, patients and insurers need to be assured of the professionalism of lifestyle medicine providers.

The group seems overly focused on distinguishing itself from alternative and complementary medicine, which I understand but find unfortunate. Then again, many practitioners of alternative medicine are less hung up on reimbursement, and considerably more willing to spend time with, and listen to, their patients than most conventional practitioners. As I have learned. (And my conventional physicians have mostly been excellent.)

My 100th post: Further thoughts on healing

This 100th post (since March 15) is contributed by Ray Purdy, and speaks to the prerequisites for a successful process of healing and conciliation.

My own (TWB) view, mirroring Ray's, is that such processes benefit from being carefully considered and planned by a skilled mediator or facilitator. A poorly considered or poorly led process can do more harm than good, reinforcing destructive preconceptions and entrenching differences, rather than reconciling them. Demands for "conciliation" mean little unless the parties have clarified their objectives and enter the process ready and willing to listen and to respect one another's fundamental humanity.

Now, back to Ray:

A couple of thoughts: This conflict has taken the form of 3 people feeling DEEPLY wounded/hurt/misunderstood. The suffering is great. The person accused of being the "wounder" feels forced into an embattled position of "I didn't do it!" The suffering is great. This is the ORIGINAL "FEELING" form of the conflict from which all else has flowed.

A win/lose situation will contribute to continued suffering on one side or the other OR both. A win/lose is guaranteed to perpetuate a trauma pattern at least unilaterally if not bilaterally. Real healing of both parties will occur only if each side feels an acknowledgement in some way by the OTHER SIDE DIRECTLY INVOLVED (as opposed to a third party acknowledgement, such as the public at large or the law school or the press).

If the goal of further interaction IS healing, a context of grudging respect for each side's humanity must develop despite the disagreements on behavior and words. Consciously committing to this goal would make it achievable. Continuing the current context of a battle for survival ON EITHER SIDE will inhibit resolution except in the form of a typical predator-prey relationship.

A conscious choice to choose the context IS available to the parties involved. What will be chosen ultimately remains to be seen.