How many times in General Practice have we had this experience?

Patient to Doctor

“Hi. I’m just here for a full check up! Top to toe, like a warrant of fitness just to make sure nothing’s wrong!”

Doctor

Nods and smiles lamely while thinking, “In 15 minutes, you’ve got to be kidding!”

Over the next 15 minutes the doctor measures pulse, blood pressure, BMI, listens to the patient’s heart and lungs, orders lipids and diabetes screening and sends the patient away with a measure of reassurance.

Increasingly, our patients are wanting to be more proactive about their health. Many are aware of the rise of chronic diseases1and as many parents have delayed starting their families2, they still have young dependent children in their middle age and don’t want anything to happen to their health! Primary care in New Zealand is more fragmented than a decade ago with many patients enrolled in a medical practice but not having personal contact with a regular GP3. Also, given our fast-paced society, busy people often utilise an urgent care service for medical care. Patients, (and GPs), are feeling the lack of continuity of care and lack of personal knowledge. Rather than pushing back at this societal change how can we become more strategic with health care delivery?

One year ago, I was invited to join a small private health screening service. Who isn’t tired of being the proverbial ambulance at the bottom of the health loss cliff and would prefer to be the fencer at the top? We developed a comprehensive health screening programme based on US Preventative Services Task Force Grade A and B recommendations4, and so Shape My Healthwas launched!

Very quickly we realised a lacking element. We were doing well at detecting risk factors for chronic disease but what to do about it? Conventional medical practice advocates lifestyle changes as the first intervention for most disease risk factors6. And here we came to a standstill, searching for a wellness model to utilise, when (drum roll…..!) we discovered Lifestyle Medicine7! Lifestyle Medicine being evidence-based, addressing the commonly known lifestyle determined health risk factors, translating population health research to the individual, and also the health coaching emphasis is the perfect answer for ameliorating chronic disease risk.

People are finding us through word of mouth, social media, GP referrals and from our advertising locally. They are offered a range of assessments from a basic nurse led half hour check with point of care testing through to executive and senior screening – a total of three-hour contact time. They receive a printed report with their health assessment details and now lifestyle recommendations. Their GPs are sent a short summary. More recently, once we had a qualified Board-Certified Lifestyle Medicine Physician8, we have added stand-alone one-hour lifestyle consultations.

Those who know me know I love acronyms! Our lifestyle programme Shape Up incorporates the ‘vital signs’of Lifestyle Medicine by using the name of our service: SHAPE.

S is for Sleep. This is a non-threatening way to start. Most people think lifestyle change is about eating better and moving more so a discussion focussing on sleep quality is surprising and disarming. It opens the way to a deeper level of what’s really going on for the patient.

H is for Happiness and includes Stress, Emotional and Mental Wellness. The majority of my consultations slow here as many patients face the impact of their personal psycho-social factors. They start to see the link to their health choices.

A is Alcohol/Tobacco/Substance use. It’s good that A follows H. Usually the both are very interconnected and the patient has a very clear understanding now of drivers behind their risky substance use.

P is for Physical Activity. More often than not this has already been addressed by the previous vital signs. Physical Activity has recently been described as the ‘Miracle Cure’10. Often the preceding goal setting has already focussed on exercise, especially outdoors, to help mood and sleeping issues.

E is for Eating Habits. I use the recently released Canadian Nutritional Guidelines11 as a baseline and also the World Health Organisation’s recommendation of a minimum of five serves of fruit and vegetables per day12. Goal setting can have a huge range of targets, with some patients only managing an extra serve of fruit per day and others embracing a trial of Whole Food Plant Based eating pattern!

Returning to our typical 15 minutes GP consultation, how can we be more strategic in the delivery of health care? Is it possible to have a plan in place for the above hypothetical patient? Here is someone willing to be proactive and engaged in their health. Is it possible for the patient to reschedule a review after the blood tests with a 30-60 minute appointment? They may have to self-fund the extra time but many patients are willing to invest in their health so it’s worth asking. Prior to this they could complete an in-depth questionnaire including medical history, family history, social and lifestyle factors to provide a baseline starting point. At the review, more time can be used in exploring lifestyle risk and goal setting. I offer my patients a one-month email follow-up with a simple appraisal of their health goals.

We really are making a difference!

This article has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.

Catherine Gray is a vocationally-registered GP practicing in Hastings, New Zealand. She obtained her Board Certification in Lifestyle Medicine in 2019, and is currently pursuing Fellowship of ASLM. 

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