After 40 years as a practicing physician, I have concluded that the burden of treating chronic diseases has grown so enormous that more pills and procedures will never be enough to cure the ills of my patients. Over those years, I also came to realize that we as physicians are failing to take sufficient advantage of one of our most powerful available tools: the ability of our patients to practice self-care.
Consider the most recent data from the Centers for Disease Control and Prevention.
- Six of every ten adults in America suffer from a chronic illness.
- Four out of ten have two or more chronic conditions
Clearly, we can never expect to stem this rising tide of disease unless we can design medical practices to promote serious behavior change. We also need to cultivate, as never before, the power of patients to take care of themselves.
Determinants of health
We have long known that some 80 percent of health is determined by factors outside of the doctor’s office. These behaviors include activities such as,
- not smoking
- moderating alcohol use
- consuming healthy food
- engaging in regular exercise
- managing stress
These are all vital components of chronic disease self-management. Improving these behaviors empowers patients to become responsible stewards of their own health and yields tangible improvement in outcomes.
Robust evidence from numerous disciplines confirms that practices such as therapeutic yoga, massage, mind-body practices, nutritional counseling, journaling, and others can enrich patients’ physical, emotional, and spiritual functioning. Yet self-care remains the subject of numerous myths and misperceptions among patients.
I believe that physicians can play a crucial role in expanding their patients’ understanding and enabling them to make important lifestyle changes to significantly improve their health.
What a new survey tells us about chronic illness self-care
Earlier this year, Samueli Integrative Health Programs commissioned two nationwide surveys by the Harris Poll. These polls involved more than 1,000 patients as well as more than 300 family medicine and internal medicine physicians.
The goal was to try to better understand how America’s doctors and their patients view and discuss self-care in their personal lives and in their conversations with each other. This is an important first step for thinking about systemic change.
Our surveys yielded new insights about a critical communications gap between doctors and their patients when it comes to taking the time and the initiative to engage in conversations about self-care that can improve health and even save lives. Among our key findings:
- Seven in 10 physicians said they believe their patients would benefit from discussing self-care with them
- Yet 75 percent of patients said they haven’t discussed any self-care with their doctors.
- Almost half of physicians (46%) believe that their patients would not be interested in discussing it
- But a strong majority of patients (72%) say they actually would like to have such discussions.
- Most respondents (73% of consumers, 92% of physicians) consider adequate sleep to be a vital part of self-care
- But only 40 percent of physicians discuss sleep habits with their patients during office visits.
Majorities of patients said they wish they could talk more to their doctors about non-medical factors that are important in their lives. They also want to discuss their life goals.
Our findings showed a sharp disconnect between patients who said they seek more help and physicians who may believe that they are already helping. For example:
- 81 percent of physicians said they refer their patients to mental health professionals,
- But only 18 percent of patients said they received such referrals
- 78 percent of physicians said they refer patients to a dietician or nutritionist
- Yet only 19% of patients report such referrals.
Patients and physicians are shying away from more self-care discussions for a variety of reasons.
Time and money are cited as the primary roadblocks:
- 44 percent of consumers believe self-care is only possible for people with “enough” time
- 35 percent believe it requires “enough” money
- More than one in four (28%) also said they feel guilty about taking the time to indulge in self-care
Chronic Illness self-care misconceptions
There are some central misconceptions about self-care including the following:
- Many patients see it as a costly indulgence, equating it with things like buying luxury skin-care products or treating themselves to a shopping spree.
- During stressful times, people often treat themselves with unhealthy behaviors, like drinking alcohol or bingeing on a tub of ice cream.
But self-care is really about finding healthier ways to nourish your body, mind, and spirit.
Majorities of patients reported awareness of the importance of getting enough sleep (66%), eating healthy foods (62%), taking care of their mental health (60%), and exercising (59%).
Doctors can play an important role by emphasizing these behaviors and suggesting other simple options such as journaling, reading, meditating, going on a walk, chatting with a friend, or playing with a pet. These are all effective ways to decrease stress and increase well-being at little or no cost.
What about complementary and alternative medicine?
It might surprise some physicians to learn that our poll found strong support for Complementary and Alternative Medicine (CAM) practices such as yoga, meditation, acupuncture, massage, chiropractic, biofeedback, and other options.
- Sixty-one percent of consumers said they have seen or used CAM practitioners and techniques in the last two years
- 69 percent said they wished their physicians offered these options in their practice.
- People who use CAM reported that they typically spend $100 a month on these practices.
It’s interesting to note that doctors themselves appear to feel defeatist about their own self-care:
- 81% of physicians say it’s very important personally for them to practice self-care
- But only 57% report doing so often
- More than three-quarters (78%) said they don’t have enough time for it themselves.
- A majority of physicians (56%) said the demands of their job prevent them from practicing self-care
- 20% said they don’t practice it because they struggle to change their own bad habits.
- Nearly one-quarter of physicians cite burnout as preventing them from focusing on self-care.
The tangible benefits of engaging in chronic illness self-care conversations
In my own practice, I have seen the tangible benefits of engaging in personal, patient-centered conversations that extend beyond conventional medicine. I offer my patients an Integrative Health & Wellness Visit. And, I do what I call a HOPE Note.
This is an interview with patients that focuses on what matters to them in their life. We also discuss how they can improve their personal determinants of health.This interaction creates a collaborative approach that enables me and the patient to become true partners.
Self-care that includes addressing the physical, emotional, spiritual, and social realms has enabled my patients to maintain or improve their health and well-being. It also helps them prevent or cope with chronic illness. Promoting self-care becomes the cornerstone of integrative health and good medicine.
The bottom line
Our survey showed us that patients have a strong desire for their physicians to be involved in more aspects of their health beyond prescriptions, test results, and diagnoses. They want a fuller partnership and relationship where they can discuss their health and well-being in other, deeper ways that impact them. As physicians, it’s important that we listen to these desires and adjust how we are treating our patients.
Reshaping Patient Engagement in a Multicultural World
Data-Driven Self-Care Will Transform Chronic Disease Management
Wayne Jonas, MD
Dr. Jonas is a practicing family physician, an expert in integrative health and health care delivery, and a widely published scientific investigator. He is currently the Executive Director of Samueli Integrative Health Programs, an effort supported by Henry and Susan Samueli to increase awareness and access to integrative health.
Additionally, Dr. Jonas is a retired Lieutenant Colonel in the Medical Corps of the United States Army. From 2001-2016, he was President and Chief Executive Officer of the Samueli Institute, a non-profit medical research organization supporting the scientific investigation of healing processes in the areas of stress, pain and resilience.
His research has appeared in peer-reviewed journals such as the Journal of the American Medical Association, Nature Medicine, the Journal of Family Practice, the Annals of Internal Medicine, and The Lancet.
Dr. Jonas received the 2015 Pioneer Award from the Integrative Healthcare Symposium, the 2007 America’s Top Family Doctors Award, the 2003 Pioneer Award from the American Holistic Medical Association, and the 2002 Physician Recognition Award of the American Medical Association.
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