Physicians play an important role in encouraging healthy behaviors, but does this advice help or harm patient satisfaction?
Fam Pract Manag. 2002 May;9(5):65.
The evidence is in: Healthy behaviors can make a difference in patients’ lives. In fact, it’s been estimated that half of all deaths in the United States could be prevented by individual changes in diet, exercise, substance use and other health habits.1
A small but growing body of evidence suggests that physicians can play an important role in encouraging patients to practice healthy behaviors. For example, almost 30 percent of Americans who have stopped smoking report being urged to do so by their physicians.1 However, while behavioral advice appears to have important health benefits, little is known about its effects on patient satisfaction. Are patients less satisfied with the primary care visit when the physician raises the issue of health behavior change?
As part of the Direct Observation of Primary Care (DOPC) Study, we examined patients’ satisfaction with visits that involved health behavior advice.2 The DOPC Study used several methods, including direct observation and patient questionnaire, to understand the content and context of 4,454 patient visits to 138 family physicians in Northeast Ohio. For this analysis, our sample included 2,459 adults who provided satisfaction information on patient questionnaires.
We found that family physicians provided health habit advice in almost half of patient visits. A wide range of behavioral topics were addressed, including exercise; diet; alcohol, tobacco and substance use; contraception; passive tobacco exposure; STD prevention; and HIV testing and prevention. In most cases, the provision of health habit advice did not affect patient satisfaction with the visit. However, when family physicians assessed tobacco use or counseled patients to stop smoking, patients reported higher levels of visit satisfaction.
Health habit advice is increasingly recognized as an important and effective tool in maintaining patients’ health. Such advice does not appear to lower patients’ satisfaction with the family practice visit. In fact, in some cases, it leads to greater satisfaction.
It is important to note that health habit advice does not have to be lengthy to be effective. Previous analyses of the DOPC data found that the duration of health habit advice is, on average, less than one minute.3 In addition, multiple visits provide ongoing “teachable moments” in which behavioral issues can be addressed. As a result, family physicians are uniquely positioned to make a big impact on patients’ health in a short amount of time, without diminishing patient satisfaction.
ILLUMINATING THE ‘BLACK BOX’ OF PRIMARY CARE
This article continues our series on the Direct Observation of Primary Care (DOPC) Study, which was funded by the National Institutes of Health and conducted by the Center for Research in Family Practice and Primary Care, with support from the AAFP. The study demonstrates the complexities of the patient visit, the demands of real-world practice and the value of primary care, issues that policymakers, the public and even clinicians have not fully understood.
Robin Gotler is project coordinator in the Family Medicine Research Division of Case Western Reserve University (CWRU).
David Barzilai is an MD-PhD candidate at CWRU. His work is supported by AHRQ grant #5T32HS00059-09.
Dr. Kikano is an associate professor and chairman of family medicine at CWRU.
Dr. Stange is a professor of family medicine, epidemiology and biostatistics, oncology and sociology at CWRU. He is also director of the Center for Research in Family Practice and Primary Care, one of three family practice research centers funded by the AAFP.
Conflicts of interest: none reported.
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1. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd ed. Baltimore: Williams & Wilkins; 1996.
2. Barzilai DA, Goodwin MS, Zyzanski SJ, Stange KC. Does health habit counseling affect patient satisfaction? Prev Med. 2001;33:595–599.
3. Stange KC, Woolf SH, Gjeltema K. One minute for prevention: The power of leveraging to fulfill the promise of health behavior counseling. Am J Prev Med. In press.
Copyright © 2002 by the American Academy of Family Physicians.
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