Editor:
I applaud the concept of healthy lifestyle advice coming from emergency physicians as Raquel Harrison, MD, described in her article. (“‘Sick or Not Sick’ Isn't the Only Question to Ask.” EMN. 2021;43[5]:29; https://bit.ly/3e6QOHx.) The vast majority of adult diseases we see are preventable, yet we are trained in intervention and think prevention is for someone else to do.
We often don't take the time to discuss changing unhealthy lifestyle habits during our busy shifts, even when it may be the obvious reason for their visit. Our high patient volumes continue because unhealthy behaviors result in more illness—the revolving door of emergency medicine—and also contribute to burnout in our profession.
In addition to a lack of reimbursement for the time spent providing health advice, other barriers include a perception of patient disinterest or ineffectiveness of advice. Studies have shown, however, that patients are interested, and the more often they hear it, the more likely they are to change unhealthy habits, even with brief health advice.
I did a master's in public health in the middle of my 35-year emergency medicine career that broadened my perspective in epidemiology and helped me think of patients in thousands or hundreds of thousands rather than just the 20 during my shift. Emergency patients are unique, and we see them during a highly teachable moment. Whether their chest pain, dyspnea, or numbness is real, anxiety, or musculoskeletal, emergency patients and their families are very receptive to health advice. We have a captive audience for a prolonged period during their near-death experience from the feared heart attack, cancer, or stroke. It is a missed opportunity not to use this heightened concern and discuss their risk factors.
We can become a model to other providers such as nurses, midlevels, and students by routinely giving health advice, sometimes brief and sometimes in detail for more receptive patients. Many patients are very motivated if you simply ask them. COVID has also provided new patient awareness of unhealthy habits and preventable disease.
We clearly do not have time during our patient encounters to say everything we would like to tell them, so I recorded a health lecture from an emergency physician's perspective with techniques to initiate and maintain behavior change, not just for frightening diseases but also for simple lifestyle choices we make every day. I offer it occasionally to patients who seem motivated to change unhealthy habits but have been unsuccessful in past attempts. I give them a card with the video title to find on YouTube: “Motivation to a Healthy Lifestyle, Dr. Rasler.” Feel free to share mine—https://bit.ly/3gC69jt—or maybe record your own advice.
Frank Rasler, MD
Atlanta, GA
