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Patient Counseling and Education: Should Doctors Be Doing More?

Jennifer Fisher Wilson
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Potential Financial Conflicts of Interest: None disclosed.

Ann Intern Med. 2006;144(8):621-624. doi:10.7326/0003-4819-144-8-200604180-00021
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Only 3% of U.S. citizens adhere to the 4 key healthy lifestyle characteristics—not smoking, maintaining healthy weight, eating adequate amounts of fruits and vegetables, and exercising regularly—according to a recent telephone survey of 153 000 adults published in the Archives of Internal Medicine. Almost 10% of the respondents adhered to none of the 4 characteristics. The ramifications of such poor health behaviors are much more important than most people realize. Smoking, poor eating habits, and inactivity contribute to more than one third of deaths in the United States, according to the U.S. Centers for Disease Control and Prevention.

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Patient Counseling for the developing world
Posted on May 13, 2006
Hassan Khan
Aga Khan University Hospital
Conflict of Interest: None Declared

The role of patient counseling in decreasing the double burden of both communicable and non communicable diseases in the developing countries cannot be over emphasized. The fact that developing countries constitute 90% of the world's preventable mortality and receive only 10 % of the global health research funding, necessitates the need for an effective intervention 1.

Infectious diseases are one of the leading causes of childhood mortality in developing nations. More than 1.9 million children have died from ARI (acute respiratory infections) in 2000, 70% of them in Africa and Southeast Asia 2. The poor health seeking behavior is one of the major reasons for childhood mortality due to infectious diseases in the developing countries. A recent study done in Rajastan, India showed that training health care workers in counseling improved the appreciation of health care seeking in mothers in the intervention group 3. The WHO estimates that seeking prompt and appropriate care could reduce child deaths due to acute respiratory infections by 20% 3. Thus patient counseling has an important role in improving the patient's knowledge of diseases and their health care seeking behavior.

The article highlights on the importance of individual counseling as a means to improve health and lower the health care expenditure in U.S. 4. In view of the limited resources, patient overload, and disorganized health structure, individual patient counseling is difficult to implement in developing countries. Instead the doctors can play a greater role by educating the society as whole in improving the overall life style behavior. This goal can be achieved via public health care seminars, dissemination of literature in local print media and primary health classes for school children.

The idea of making money through writing green prescription is a good incentive to promote counseling 4. However it might not get popular amongst patients due the high levels of commitment and compliance needed for implementing lifestyle modification. The poor patient health seeking behavior is likely to get worse when no rapid health benefits are seen with life style changes. Only patient health education will improve both compliance and acceptability of such behavioral modifications.

In the wake of the globalization of unhealthy practices the non communicable disease will soon form the major cause of morbidity in developing nations. Already 1.2 billion smokers, 80% of them reside in the developing world 5. Thus patient counseling for improving lifestyle and health seeking behavior may be the only gun for doctors to shoot with.


(1) Global Forum for Health Research. The 10/90 report on health research 2003-2004. Geneva: Global Forum for health research 2004

(2) Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C. Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis. 2002;2:25-32.

(3) Mohan P, Iyengar SD, Martines J, Cousens S, Sen K. Impact of counseling on careseeking behaviour in families with sick children: cluster randomised trial in rural India. BMJ 2004;329:266-9

(4) Wilson JF. Patient counseling and education: should doctors be doing more.Ann Intern Med. 2006;8:621-4.

(5) Boutayeb A, Boutayeb S.The burden of non communicable diseases in developing countries. Int J Equity Health. 2005;4:2.

Conflict of Interest:

None declared

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