Patient Counseling and Education: Should Doctors Be Doing More?

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.

Although smoking rates in the United States have declined from 42% in 1965 to about 20% in 2005, obesity rates have skyrocketed. Today, 65% of U.S. adults are overweight (body mass index ≥25 kg/m²) compared with 33% in 1950. The increase portends an epidemic in weight-related complications that U.S. Surgeon General Richard Carmona, MD, calls the greatest threat to public health today.

The trend can be reversed, of course: Smoking cessation reduces the associated risk for lung cancer, stroke, chronic obstructive lung disease, and coronary heart disease. Improved diet and exercise habits reduce the risk for diabetes, sleep apnea, cancer, hypertension, and heart disease. United States citizens know this, but too few practice the eating and exercise habits that are good for their health. Maintaining these habits in today's car-dependent, excess-prone society is not easy, and breaking bad habits is hard.

Should doctors be doing more to help? Prevention is, after all, a core tenet of medicine, and health promotion can result in healthier patients. But whether doctors recognize and embrace this responsibility is another matter. Few physicians have training in the specific skills of health promotion. Doctors are already stretched to the limit in caring for their patients' more immediate …