The physician's role in promoting healthy behaviors: Two patients
The aim of ProCor's "Clinical Encounter" series is to share vignettes embodying diverse aspects of cardiovascular care that maximize the physician-patient relationship and noninvasive approaches. We hope that this becomes an ongoing dialogue and serves as a platform for other physicians to share their thoughts and experience.
I saw two patients recently who exemplify the powerful changes that individuals can make in their lives with education and encouragement from a physician. By helping patients understand that their bodies can, on their own, produce the most powerful drugs necessary for a healthy heart, we can be the catalysts for them taking a more proactive role in their physical wellbeing.
The first patient was a teacher until the age of 62, when he had a heart attack. At the time of his MI, he weighed 242. Today he weighs 194, has retired from teaching, and works as a fisherman, happily spending his days on his boat hauling heavy traps out of the water.
The second patient had a heart attack at the relatively young age of 28. He also was overweight at the time, and has since decreased his weight from 226 to 182.
Both managed to achieve a healthy weight by making modest changes in their daily nutrition and physical activity. They didn't require surgery, expensive fitness clubs, or fad diets. Theirs was a disease of excess, and their heart attacks provided the necessary motivation to make changes that have made them healthy and, in both cases, happier human beings. It's a pleasure to see and support their ongoing commitment to their health.
I've found that taking the time to explain the biology of coronary atherosclerosis can often produce positive results. I don't deliver a lecture, point to wall charts, or demonstrate diseased arteries with plastic models. I begin by explaining that coronary atherosclerosis is a silent process, generally not noticed until a person has a heart attack. I emphasize that a heart attack can t be predicted for any individual. Coronary artery disease is a frightening and/or unreal phrase for most people. To help a patient understand what takes place, I use a pen and paper to draw a simple diagram of a normal blood vessel--just a few lines, showing the lumen and the vessel wall. Then I draw another artery showing unrestricted flow with a plaque, and a third diagram showing an obstructed artery.
Acknowledging that we can minimize plaque progression and strengthen the overlying fibrin cap with statins, I explain to the patient that even more powerful in producing healthy blood vessels are the enzymes and hormones that are released in the body with regular exercise. For many patients, it is a revelation that thirty minutes of physical activity can affect nitric oxide release which scavenges free radicals and creates anti-inflammatory effects that further strengthens the fibrin cap and prevents rupture of the plaque.
Simplifying this complex theory to an understandable form is an effective way of motivating patients to make positive changes to protect their health. When they begin to include 30 minutes of activity in their daily routines, they feel better and shed pounds. This provides a positive reinforcement of their behaviors. Equally powerful is their realization that "There's something I can do."
Explaining the biology of coronary atherosclerosis combined with motivation to exercise and advice directly from a physician is often effective and synergistic. Most patients are willing to take their health seriously if they are helped to understand and to feel sufficiently empowered. Patient care is a partnership. Educating and encouraging the patient to take responsibility empowers him or her, and is an effective tool in health care.
In "The Forgotten Majority: Unfinished Business in Cardiovascular Risk Reduction" Peter Libby, MD, writes "Physicians and other health care providers must redouble efforts to educate the public regarding the health benefits of a prudent diet and regular physical activities. Considerable barriers exist to lifestyle change, which we must address with education of both the public and physicians and with unrelenting efforts to improve implementation of sustainable lifestyle changes" (1). Robert Goldberg's recent commentary on the WHO-PREMISE study similarly notes, "The quality of patient and provider relationships needs to be improved upon, including recommendations for various health promotional activities and use of secondary prevention modalities in appropriately targeted individuals" (2).
1. J Am Coll Cardiol 2005;46-1225-8
2. ProCor Global Dialogue, 18 Nov 2005
Date Posted: 8 December 2005