The physician's role in health-promotion and disease prevention

There are current inadequacies in medical practice related to prevention of disease, risk reduction, or health promotion. This includes both primary and secondary prevention. While physicians have increased their awareness and acceptance of a role in these areas, they perceive their efforts to influence patient health related behavior, such as smoking cessation, reduction of weight or dietary fats, or control of alcohol abuse, as achieving success in only about 5% of their patients. Such patient care outcomes discourage physicians from continuing an active role in these areas. Inadequate physician-patient communication, such as with long-term compliance with treatment for hypertension, further diminishes the effectiveness of physician efforts. Despite the perceived poor outcomes, physicians believe that they could be considerably more successful in influencing patient behavior with proper training and skill development as well as improved use of other resources. This paper has described efforts to improve physician skills and effectiveness by use of continuing educating workshops led by peer physician educators and conducted through state and local medical societies. These approaches are purposely developed to be skill-oriented and feasible for use within the usual constraints of practice. Moreover, the approach emphasizes peer influence by physician educators in the same practice circumstances as those colleagues they are attempting to educate and influence. This maximizes the acceptability of the approach to physicians and the likelihood that it will be practiced effectively. Results to date indicate that such approaches are acceptable to physicians, utilized in primary care practice, and associated with improvement in patient care in regard to high blood pressure control, smoking cessation, and control of hyperlipidemia. Such efforts can have direct impact on morbidity and mortality, as noted from the analyses of hypertension control. Other intervention approaches for control alcohol and drug abuse are being developed. The approach here is presented as one model to enhance the role of the physician in health promotion and disease prevention.