Tuesday, October 26, 2010


Research published in this month’s American Journal of Preventive Medicine indicates that when a physician advises a patient to lose weight, the patient does or doesn’t depending on the physician’s counseling style.

The most successful style is a back-and-forth conversation. E.g., “What are your feelings about your weight?” The least successful is where the doc alone speaks. E.g., “You know, you really need to knock off twenty or thirty pounds.”

If you’ve been reading this blog, I guess this conclusion isn’t earthshaking news.

The lead researcher, Dr. Kathryn Pollak, an associate professor of community and family medicine at Duke, put her finger on it when she said, “When it comes to behavior change, the patient is the expert, not the doctor…The whole point is to help the patient solve the problem himself…Doctors are hearing the message that they need to do something. They’re trying, but they’re not doing it right.”

It’d be nice if they were doing it right, but really: whose job is it to motivate the patient to change, anyway? 

My physician friends tell me the majority of their patients suffer from diseases—including emphysema, obesity, type two diabetes, and hypertension—that arise from pathogenic lifestyles. Docs can clean up some of the damage, but that approach essentially enables self-destructive behavior. It’s an expensive, high-tech turnstile which certainly keeps the wheels of commerce spinning but doesn’t elevate the general health.

Here’s one of my favorite quotations, by John Knowles, M.D.,late President of the Rockefeller Foundation and Medical Director of Massachusetts General Hospital:

"The people have been led to believe that national health insurance, more doctors, and greater use of high-cost hospital-based technologies will improve their health. Unfortunately, none of them will. The next major advances in the health of the American people will come from the assumption of individual responsibility for one's own health and a necessary change in the life style of a majority of Americans."

He said that some thirty years ago. Are things better now? One can hope…

By the way, I’m going away for a couple of weeks, so if you’re a regular reader of this blog be sure to tune in again in mid-November.

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