Do We Practice What We Preach?
A Survey of DCMS Physicians

Editors Note: This abstract tackled a topic that hits close to home for our readers, so in the spirit of healthy self-examination we've included the expanded article here. The work was authored by Anna M. Wright, MD; Joy Ablordeppey, MD; Fern J. Webb, PhD; Department of Community Health and Family Medicine, University of Florida Health Science Center, Jacksonville. The authors acknowledge that their research was sponsored by an unrestricted educational grant provided by Wyeth-Ayerst Pharmaceutical Company.

Survey Results at a Glance
Background

It would be impossible to count the number of times you've found yourself counseling a patient on a specific health habit or on the importance of overall health maintenance. But do we as physicians heed the messages we give patients? Are we practicing what we preach as it relates to our own health care? Physicians are vital sources of patient education and are generally viewed by patients as credible sources of information; but in our busy, frenetic medical world, there is little time to thoroughly share this information with our patients. Do DCMS physicians find a way to impart this health information to their patients, and do these physicians' own health habits reflect the health promotion messages they preach?

Patient Health The primary causes of morbidity and mortality in the U.S. are largely attributable to unhealthy personal behaviors: smoking, excessive alcohol use, sedentary lifestyles, high fat diets, and failure to use seatbelts. Although close to 80% of American adults visit a physician at least once a year, millions of Americans do not obtain routine screening and health habit counseling as recommended by such groups as Healthy People 2010, United States Preventive Services Task Force (USPSTF), and the American Cancer Society. 1,2,3,4

Patient View of Physician Health Counseling Eighty percent of Americans cite their physician as their primary source of health information. At healthcare visits, patients may be especially receptive to information about health habits.5 While written patient education materials are helpful, they work best in conjunction with verbal information. Patients who receive written information on smoking, diet, and exercise after receiving physician counseling are more likely to read the materials, remember the information, and share the information with others (as compared to patients receiving written information only).6 Studies demonstrate that counseling patients about healthy habits positively influences a patient's health practices and even a brief message during an office visit can substantially increase a patient's change in a health habit, such as smoking.7

Physician Health As a group, physicians tend to be fairly healthy, and physicians' use of formal health services is one quarter of the national U.S. average. Only 50-66% of physicians have a primary care physician or regular source of care.8,9 This may represent a tendency to self-treat or utilize "curbside" care.7,8 A study of 915 Johns Hopkins graduates revealed surgeons, internists, pathologists, and subspecialists were less likely to have a regular source of care.10 Based on mortality outcomes in a review of physician mortality, physicians make healthy personal choices; male physicians outlive other males including lawyers and other professionals.

Physician Characteristics and Counseling Practices Cigarette smoking by physicians has declined dramatically, and physicians who do not smoke are significantly more likely to counsel their patients about smoking cessation. Physicians who exercise, have good personal health habits, or are trying to change a personal health habit are more likely to counsel patients.11,12,13 Physicians with poor personal health habits are less likely to counsel patients. Younger physicians are more likely to counsel. Primary care physicians (FP, IM) counsel more than specialists. Physicians who feel counseling is important do more of it.14 Although each doctor-patient encounter is an opportunity to provide preventive medicine counseling, barriers which prevent physicians from counseling also include: time constraints, lack of training/knowledge, attitude (waste of time), lack of resources, and lack of reimbursement.2 Three physician characteristics that strongly influence physician practices in counseling patients on health habits are 1) clinical specialty, 2) physician beliefs/attitudes about counseling, and 3) physician personal heath habits.

Purpose

The purpose of this study was to determine (A) whether DCMS physicians practice good health habits and adhere to standard health screening, and (B) if DCMS physicians' personal health habits influence their patient counseling on health habits.

Methods

A cross-sectional survey was sent to 337 primary care physicians (Family Medicine, Internal Medicine, and Obstetrics/Gynecology) registered with the Duval County Medical Society in Fall 2001. An anonymous one-page survey questionnaire was developed to obtain information on physician personal health habits, personal adherence to standard health screening as recommended by the USPSTF16, and patient counseling practices on health habits and screening. The survey was kept short and simple to encourage participation. Descriptive and analytic analysis were determined using SPSS v10.1 and SAS v8.02.

Results

One hundred seventy surveys were returned for a 50% return rate. 49% of respondents were family physicians, 26% were internists, and 25% were OB/GYN. The characteristics of respondents are listed in the chart on the opposite page.

Do physicians practice what they preach?

Several interesting although not statistically significant results emerged:

  1. Although 70% of physicians in this study encouraged their patients to exercise, only 48% of physicians actually engaged in regular exercise (defined as running, walking, gardening, aerobics, etc. at least three times a week).
  2. Ninety-eight percent of physicians recommended colon cancer screening, and 75% of physicians over age 50 reported having colon cancer screening.
  3. While almost all physicians recommended flu shots (95%), 79% of physicians reported receiving a flu vaccination in the past year.
  4. Seventy percent of physicians counseled patients about living wills, although only 48% of physicians reported having a living will themselves.

When stratifying respondents by sex and specialty, several patterns emerged:

Male physicians were more likely to be screened for colon cancer, have a living will, and to wear a seatbelt, while female physicians were more likely to exercise and consume alcohol. Internists and obstetricians were more likely to consume alcohol, while family physicians were more likely to be screened for colon cancer and wear seatbelts.

Do physicians preach what they practice?

Statistically significant analysis showed two clear correlations:

  1. DCMS primary care physicians who receive flu vaccinations are 16 times more likely to encourage patients to get a flu shot. (p< 0.01; CI: 3.21-111)
  2. DCMS physicians who wear seatbelts are seven times more likely to counsel patients about seatbelt safety. (p< 0.05; CI 1.52-35.8)

A general pattern emerged that physicians who counsel patients on health habits are more likely to practice good health habits. Physician success in improving the health behaviors of patients is closely related to physician health behavior.2,3

 

Survey Results At A Glance
Average age of this survey's 170 respondants: 46 Average BMI: 25.3
Blood pressure averaged 120/74 Years in practice, on average: 14.3
Almost everyone (90%) reported using seatbelts, 67% say they exercise regularly,
and fewer than 1% report smoking tobacco. 		A majority (68%) of respondants over the age of 50 have undergone colorectal screening,
and 79% have taken a flu shot.
38% of respondants were female. Cholesterol levels averaged 186
70% of respondants normally consume some alcohol with an average of three drinks per week. 11% of respondants who say they drink also say they drink more than they'd like to,
and 5% say they really should cut down.
When it comes to advance planning, respondants were firmly in the "Do as I say, not as I do" category: While 70% of physicians counseled patients about living wills, only 48% have one themselves.

Conclusions

This study suggests that DCMS internists, family physicians, and obstetricians counsel their patients regarding health habits more than they practice them. DCMS physicians who report practicing good health habits are significantly more likely than their colleagues to counsel and encourage patients (flu shots, seatbelt use, living will). These findings are similar to other studies. 2,3, 15

A second mailing of the survey was sent to 206 non-respondents four weeks after the initial mailing and we received 38 completed surveys. As the data from the second group were tabulated, an interesting finding emerged. The respondents who returned the survey after the second mailing were older, had a higher BMI, cholesterol, and blood pressure than initial survey responders. Although not clinically significant, it seems those who were less likely to practice what they preach may have been reluctant to participate in the study. Perhaps this group is busier than the initial respondent group and therefore, less likely to engage in healthy behavior or to have time to complete a survey!

Study Limitations

This study was designed to be short and simple to encourage the busy clinician's participation. Therefore, many questions were limited to yes or no answers and numerous health questions were not included. An exhaustive, intrusive questionnaire would likely have resulted in a much lower response rate; for that reason we purposely omitted many health habits. Questions about PAP smears and mammograms were included in the survey, but were not included in the data analysis due to an error in the survey tool.

Recommendations

The more physicians practice good personal health habits in their own lives, the more apt they are to counsel patients to make important strides towards improving health habits. If we practice what we preach, then we'll be more likely to "preach what we practice." Our health and the health of our patients will benefit.

REFERENCES

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  2. Lewis CE, Wells KB, Ware J. A model for predicting the counseling practices of physicians. J Gen Intern Med 1986;1:14-19.
  3. Bortz WM. Health behavior and experiences of physicians:results of a survey of Palo Alto medical clinic physicians. West J Med 1992 Jan;156:50-51.
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  14. Wells KB, Lewis CE, Leake B, Ware JE. A study of doctors' health habits and counseling practices. JAMA 1984;252:2846-2848.
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  16. U.S. Preventive Services Task Force. Guide to clinical preventive services, 2nd ed. Baltimore: Williams & Wilkins, 1996.

Jacksonville Medicine Resident Research 2003

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