The burden of chronic disease in the United States is enormous. Six out of every 10 adults suffer from a chronic illness, and four in 10 have two or more,(www.cdc.gov) according to the CDC. Relying only on the medical system to provide pills and procedures to try to treat these diseases is not enough. We cannot expect to stem the rising tide of chronic illness unless we can design medical practices to promote serious behavior change and self-care among patients.
Wayne Jonas, M.D.
Numerous meta-analyses, literature reviews and large-scale epidemiologic studies support the safety, efficacy and cost-effectiveness of chronic disease self-management.(www.ncbi.nlm.nih.gov) In fact, self-management techniques have been lauded for successfully meeting the triple aim of improved health, improved care and reduced costs.(www.ncbi.nlm.nih.gov) Although more data from larger randomized trials will always be beneficial, there is already robust evidence to suggest that therapeutic yoga, massage, nutritional counseling, mindfulness, exercise and similar self-care approaches can enrich patients' physical, emotional and mental health, as well as their well-being.
So why aren't physicians doing more to promote the kinds of self-care that patients need? And how can we do a better job of changing their lifestyles?
My organization commissioned The Harris Poll to conduct two nationwide surveys about self-care that involved more than 1,000 adults and more than 300 family medicine and internal medicine physicians. Our findings, summarized in a report issued in July,(drwaynejonas.com) yielded new insights about a critical communication gap between doctors and their patients concerning health. This gap, which highlights physicians' failure to engage in meaningful conversations about self-care, means we are missing a major opportunity to improve health and even save lives.
Among the key findings: On average, physicians say seven in 10 patients would benefit from discussing self-care with them, yet 75% of patients say they haven't discussed any self-care with their physicians within the past two years.
Almost half of physicians (46%) believe their patients would not be interested in discussing self-care, but a strong majority of patients (72%) say they would like to have such discussions. For example, two out of three patients say they want more self-care resources from their primary care physicians, and a majority of patients say they wish they could talk more with their doctors about nonmedical factors that are important in their lives and life goals.
But physicians aren't making these discussions a priority. One of the main reasons for this is a lack of time during appointments. In fact, 78% of physicians say this is the top reason they don't discuss self-care with their patients during more clinic visits; it is also one of the reasons physicians say they can't personally practice their desired amount of self-care.
Doctors themselves appear to have a defeatist attitude about encouraging self-care: 80% of physicians say it's extremely important personally for them to practice self-care, but only 57% report often doing so. Roughly three-quarters (72%) say they don't have enough time for it themselves. Most physicians (56%) say the demands of their job prevent them from practicing their desired amount of self-care, and 45% say they don't practice it because of demands from their family. Additionally, nearly one-fourth of physicians cite burnout as preventing them from focusing on self-care -- one of the very things that would help them address burnout.
These data support what is happening within the physician workforce -- physicians are often stressed, run-down and struggling with their own health and well-being, which in turn can affect how they treat patients. Evidence has shown(www.ncbi.nlm.nih.gov) that physicians who engage in healthy behaviors have a lower risk of burnout, and those who engage in their own self-care are more likely to talk with patients about self-care.
Aside from finding personal opportunities to take care of themselves, the other solution to this problem is to change the fundamental structure of the health care system by moving away from the treadmill of the fee-for-service model. Integrating teams, tools and technologies are required to support behavior change.
Our health care system makes it difficult to have self-care discussions during patient visits. Time is a crucial factor in delivering high-quality health care, improving communication and developing a good relationship with patients. But the increasing administrative burden placed on doctors frequently requires their attention for nonmedical matters, such as documentation and coordination of care. Simply put, physicians are not able to spend time where we are most needed -- with the patient.
The issue with time can be addressed in various ways. For instance, having a more integrative system would be more efficient, freeing up time to address key social determinants of health. Incorporating team-based care by including health coaches, medical assistants and others to provide self-care services would help provide more time for physicians to have conversations with patients and point them in the direction they need to go. Behavior change technologies and artificial intelligence can also help in ways that do not require more time from the physician. Commercial software and self-care management tools for patients can facilitate self-care by helping them track food and movement and aiding with stress management and social support.
There are ways we physicians can implement these approaches in our practices. For example, physicians can offer an integrative health visit using a tool such as the Department of Veterans Affairs' Personal Health Inventory(www.va.gov) or the Healing Oriented Practices & Environments (HOPE) note.(drwaynejonas.com) Both tools specifically address questions about self-care that are currently missing from most office visits and can help fill these gaps in communication. Using tools like these will bring out the patient's own engagement in their personal determinants of health. This allows for a deeper, richer and more personally relevant conversation and helps physicians guide patients more effectively in self-care.
Wayne Jonas, M.D., is the executive director of Samueli Integrative Health Programs and author of "How Healing Works." He is also a practicing family physician and a retired lieutenant colonel in the U.S. Army Medical Corps.