Section 4: The Role of Physician in LSM 4%

Question 1

What did the 2009 survey Californian physicians reveal about health-behaviours in physicians with regards to stress, exercise, sleep, and use of tranquilisers: (n=763, 41% response rate)

Answer 1

53% severe to moderate stress

35% no, or occasional exercise

34% 6 or fewer hours of sleep

27% never or occasionally ate breakfast

13% used sedatives/tranquilisers

7% depressed

4% used marijuana

Question 2

What proportion of physicians were obese in the 2012 survey primary care physicians (n=498) ?

Answer 2

53% were obese

Question 3

what did the 2013 survey (n=883, 62% response rate) of Canadian 4-y med students show with reg to physical activity?

Answer 3

36% did not meet physical activity guidelines

Question 4

How do physicians personal practices influence patient outcomes in terms of physical activity?

Answer 4

Physicians who practice healthy lifestyle are more likely to offer counselling and improve patient outcomes

Drs who exercise are more likely to counsel patients on exercise

Metaanalysis 24 studies, 19 studies OR 1.4 to 5.7 (P<0.05)

Question 5

How do physicians personal practices influence patient outcomes in terms of nutrition, lipids and wt management?

Answer 5

Drs more likely to record Dx of Obesity if perceived patient’s BMI to be greater than their own

If Dr eat less fat, the counsel more on cholesterol (P=0.08)

If Dr eats 5+ a day, more likely to counsel on nutrition (P=0.046)

Vegetarian physicians, more likely to counsel on weight loss and nutrition (OR 2 and 2.1 respectfully)
cross sectional study of 1349 internists, P<0.01

Question 6

How do physicians personal practices influence patient outcomes in terms of smoking, alcohol use and safety behavior?

Answer 6

Non-smoking physicians are more likely to emphasize risk of smoking
MALES: personal health practices for smoking, etoh, seatbelt use and physical activity were POSTIVELY associated with counselling for each behaviour EXCEPT for etoh use!

Question 7

Briefly outline steps to assess Physician’s personal readiness and develop a personal action plan

Answer 7

1. Pick a focus area or behaviour to change/improve
2. Assess transtheoretical stages of change (Section 2)
   Precontemplative, contemplative, preparation, action, maintenance, relapse.
3. Assess personal confidence in provider’s own ability to change
4. Assess perceived importance of making a change
5. Develop a specific action plan: SMART goals (Specific, Measurable, Achievable, Relevant, Time)
6. Create a personalised monitoring system:
   Daily log, checklist, regular accountability meetings, support team.
7. Follow up at regular intervals
8. Reassess progress, confidence, importance of making a change, celebrate successes, brainstorm ways to overcome barriers

Tools to assist

Reward programmes e.g. MHealthy Rewards

Specific tools for providers e.g. ePhysicianHealth, AMA International Conference on Physician Health,
AMA Code of Medical Ethics – Physician Health and Wellness

Question 8

What tools can be used to assist personalised action plan for positive beh change, including plans for physicians?

Answer 8

Reward programmes e.g. MHealthy Rewards

Specific tools for providers e.g. ePhysicianHealth, AMA International Conference on Physician Health,
AMA Code of Medical Ethics – Physician Health and Wellness

Question 9

describe different startegies for incorporating wellness programs for providers.

Answer 9

Accessibility
Employee wellness programs
On site gym
Local gym discounts
Culture of Wellness in the office
Promote healthy meals
Standing work stations/treadmill desks
Colleageal health challenges and competitions
Allowing provider time to get involved in local community changes that supports healthy living
Sets example for patients

Question 10

Mobilising physicians for community level
change: outline possible strategies to conduct effective lifestyle medicine advocacy directly with patients, their families, community policy makers and decision makers

Answer 10

Advocacy
Interacting with influencers
Local, state and federal levels
Community advocacy
Identify and target wellness needs
What’s the community’s role in addressing the need
Working with community organisations and local partners
Example: school lunches, walking paths, safe places to play, neighbourhood design

Question 11

outline examples of conducting effective lsm advocacy for patients and their communities

Answer 11

Blue Zone Project (international)
Longevity project – 9 characteristics – movement, sense of purpose, mainly plant-based diet, stop eating after 80% full,
relax, down-shift, family first, right tribe, belong to something greater

Robert Wood Johnson Foundation “Creating a Culture of Health”

Dean Ornish’s Plant-based cardiac rehabilitation programme

Question 12

outline advocacy check list for conducting ls change

Answer 12

Define the problem and desired solution

Consider health trends in the community and what impact it has on advocacy efforts

Reflect on current issues to help address OR worsen the problem

Problem solve: what’s the solution like short term and long term

Consider why the community should support the initiative

Know your audience

Who are the key stakeholders, build connections, current trends and mindsets

Who will HELP? Who will OPPOSE?

Timing? E.g. election season, etc

Determine strategy, tactics and timeline

Who, when, how

Evaluate outcomes

Identify metrics to be tracked

Pre-determine what a successful intervention will look like