Time to Talk Lifestyle

Boston enjoyed the first snowstorm of the season this week, and I was lucky enough to have clinic scheduled smack dab at the height of it. We pretty much never cancel clinic for a snowstorm, though there have been blizzards when I literally couldn’t get out of my driveway, and I had to cancel. This storm was only low-medium on the weather impact scale: Dangerous because of the layer of frozen slush under fresh fluffy snow, and annoying because of the whipping wind.

So at 6 a.m., I layered up and made my way to the bus that takes me to the train that takes me to work ,wondering how many patients would show.

What was fascinating was that the sick folks cancelled, but the physical exams showed up, and on time, no less! Three women, all in different age groups and life stages, got geared up and over to my office for their wellness exams. I had a full hour with each of them, which was just so awesome. We had long conversations catching up with a year’s worth of career and family changes, and of course, really delving into all the lifestyle stuff I live for.

*One young patient is struggling with fitting fitness into her schedule, so I ran a mini-coaching session with her, and we came up with a bunch of options she can try for working activity into her regular days. This is important to her because she has a strong family history of heart problems. I emphasized that every little bit of movement can help prevent major diagnoses later. It all counts. She feels she can be an example for her other family members who live very unhealthy lives, and that this will help keep her motivated.

A middle-aged patient hates to cook, but has figured out ways to make it tolerable, as she tries to eat a more plant-based diet. We were able to talk recipes and strategies, right down to wine recommendations (quality wine is less likely to have chemical additives that upset the stomach, FYI). She’s been able to stick to a consistent pilates routine for a year, and noted that she went down a clothing size as a result. We talked about how important it is to maintain muscle mass, flexibility, and balance as we age, and I congratulated and encouraged her efforts.

A working mom is having relationship issues, and as her partner is her main source of support, we spent time discussing what’s working and what’s not and where to go from here. She also belongs to a local moms group, an additional source of support. She’s has post-childbirth pelvic floor issues, and we spent time discussing physical therapy as well as pilates and core strengthening.

These interactions were meaningful, not chatter or light conversation. We were able to focus on lifestyle factors that are critical for long-term good health. This is what primary care should be doing. We need more time to talk with patients about healthy lifestyle, which includes nutrition, physical activity, sleep, stress reduction, and social connection.

Though the snowstorm is what made these luxuriously long clinic encounters possible, I do believe that primary care is changing. There’s a shift from “Give me a pill” to “Tell me how I can avoid a pill”. More and more, patients want to know what they can do rather than what they can take.

Medicine is waking up, too. The research supporting lifestyle for disease prevention– healthy habits, essentially– is overwhelming. Doctors should be familiar with the science, asking patients about their main lifestyle habits, and counsel towards improvements. The good news is that more and more doctors are doing this.

In the meantime, I’ll take another slow snowy clinic day so I have time to talk with my patients about what really matters.

*All patient encounters have been altered somewhat and any specifics omitted so no one can be identified.