Healthy Physicians Equal Healthy Patients

Abstract & Commentary

By Rahul Gupta, MD, MPH, FACP, Clinical Assistant Professor, West Virginia University School of Medicine, Charleston, WV. Dr. Gupta reports no financial relationships relevant to this field of study.

This article originally appeared in the May 29, 2013, issue of Internal Medicine Alert. It was edited by Stephen Brunton, MD, and peer reviewed by Gerald Roberts, MD. Dr. Brunton is Adjunct Clinical Professor, University of North Carolina, Chapel Hill, and Dr. Roberts is Senior Attending Physician, Long Island Jewish Medical Center, NS/LIJ Health Care System, New Hyde Park, NY. Dr. Brunton serves on the advisory board for Abbott, Amarin, Boehringer Ingelheim, Duchesnay, Janssen, Lilly, Novo Nordisk, Sunovion, and Teva; he serves on the speakers bureau of Boehringer Ingelheim, Janssen, Lilly, Novo Nordisk, and Teva. Dr. Roberts reports no financial relationship to this field of study.

Synopsis: More patients who received a preventive medicine intervention also had their physician receive the corresponding preventive intervention.

Source: Frank E, et al. The association between physicians’ and patients’ preventive health practices. CMAJ 2013; Apr 8. [Epub ahead of print.]

It is well established that physician recommendations can have a significant impact on the lifestyle behavior of their patients. Whether it is diet and exercise, immunizations, or cancer screenings, a physician recommendation for such preventive measures is a good predictor for outcomes. However, increasingly our patients are evaluating not just the advice but also the ability of their own physician to “walk the talk.” In a British study, researchers found that only one in five physicians get the recommended 30 minutes of moderate exercise at least 5 days a week.1 Although these physicians blamed lack of time, lack of motivation, or lack of workout facilities, those with an on-site gym at their hospital did not fare any better than those without, and one-third of them were not even aware of the existence of such a facility. Existing research, mostly based on self-reported data, also demonstrates that physicians who practice healthy lifestyle habits themselves are more likely to play a significant role in helping their patients adopt healthy lifestyles for primary prevention of chronic diseases.2

In their research, Frank et al used data from Israel’s largest health maintenance organization (HMO) to assess various indicators of quality health care for primary care physicians and their adult patients. Since this particular HMO covers more than 50% of Israel’s population, including physicians, the study included accessing data on almost 2 million adults and 1500 primary care physicians. Eight prevention-related health quality indicators were examined. These included age-based screenings for breast cancer, colorectal cancer, cholesterol, pneumococcal, and influenza vaccines, as well as three different age-based screenings for hypertension.

Researchers found that for all eight indicators, patients whose physicians were compliant with the preventive practices were more likely (P < 0.05) to also have undergone these preventive screenings themselves as compared to patients with noncompliant physicians. For example, patients of those physicians who themselves received the annual influenza vaccine were 13.7% relatively more likely to receive the vaccine than those whose physicians did not receive the vaccine. The study demonstrated a statistically significant difference for all eight preventive interventions. There was some overlap between closely related preventive practices. For example, among patients whose physicians received the influenza vaccine, 60.9% of eligible patients also received the pneumococcal vaccine, compared with 56.8% of patients whose physicians did not receive the influenza vaccine (7.2% relative difference, P < 0.001). However, a similar benefit was not found across the category of preventive service. For example, mammography rates for patients were not influenced by whether their physicians had received the influenza vaccine.

Commentary

As a profession, we have not always taken good care of ourselves. Beyond a handful of health care systems, a systematic support system for physician health does not exist across our nation since most policy makers already believe that “we are the docs so we must know how to take care of ourselves.” On the other hand, it seems like common sense that physicians who believe in preventive practices enough to undergo those services themselves are more likely to effectively counsel their patients about them. The study by Frank et al reinforces that “healthy physician-healthy patient” relationships are more closely related than we once thought. Probably applicable to primary care physicians in United States, this study demonstrates that there is room for improvement in our own preventive practices. Adhering to preventive medicine guidelines personally will not only facilitate counseling our patients better and become more effective in obtaining compliance, but it may help improve our health and wellness as well. Almost three-quarters of the $2.7 trillion U.S. health care spending (about 18% of our gross domestic product) is spent largely on preventable chronic illnesses such as obesity, diabetes, and heart disease. Perhaps with the current national focus on prevention, we can take advantage of the opportunity by individually adhering to the screening recommendations by the United States Preventive Task Force, which may further aid and reinforce a strong physician-patient relationship.3 While I am not entirely convinced that preventive care only will significantly reduce these high costs, especially since some of the measures actually do not contribute to improved health status, I do believe in the observation once made by Thomas Jefferson “the ground of liberty is won by inches.” Gradually, we will get there!

References

1. Gupta K, Fan L. Doctors: Fighting fit or couch potatoes? Br J Sports Med 2009;43:153-154.

2. Oberg EB, Frank E. Physicians’ health practices strongly influence patient health practices. J R Coll Physicians Edinb 2009;39:290-291.

3. Recommendations of the U.S. Preventive Services Task Force: Abstract. September 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.uspreventiveservicestaskforce.org. Accessed May 8, 2013.