A recent study on differences in the education of patients with chronic illnesses by the provider type caught my attention. The study, in the CDC’s Preventing Chronic Disease, claimed that physician assistants (PAs) and nurse practitioners (NPs) are more likely than physicians to advise patients with chronic illnesses on how to live healthier lives. The reasons for this claim seemed a little unclear to those who conducted the study, but for me, it hardly takes a data set to explain. After reading this study I started to think about the differences in types of medical education, the high volume of patients physicians see, and my own personal experiences.
My undergraduate studies were in Nutritional Science with a Pre-Med focus. Coupling that curriculum with the real-life experience of shadowing local surgeons, my eyes were opened to the lack of emphasis on wellness education within traditional physician practices.
I think back to when I was shadowing an orthopedic surgeon who used a steroid injection to the joint to treat one patient’s arthritis. This is the standard procedure for such a treatment; however, I couldn’t help but feel that there was more to do that would better treat the whole condition. This particular patient was also morbidly obese and suffering from severe depression, but the doctor unfortunately only had the time to inject the steroid and move onto the next patient.
It all happened so fast that it wasn’t until the doctor was cleaning up that I asked the patient what she liked to do for exercise. I was probably overstepping my boundaries here, but thankfully the doctor allowed me to ask the patient some personal questions. The patient told me about how much she loves to swim because of the relief it provides to her joints. She then mentioned taking a certain antidepressant that made her gain significant weight, therefore making any activity increasingly difficult. I felt so helpless knowing the patient was giving us all of the right information, but the doctor was not really using it due to time constraints and training.
At that time, I had expected that the doctor would try to suggest alternative exercises or another visit to the doctor prescribing the anti-depressant to try a medication that did not cause as severe of weight gain. I thought that maybe he would try educating the patient on other lifestyle changes like diet and stress management. Instead the doctor shook the patient’s hand and left the room late to see his next patient, and most likely expecting to see the patient again for another injection.
This encounter was not wrong by any means. The physician’s training most likely never covered counseling on diet and nutrition, weight reduction strategies, or stress management. The doctor did exactly what he was supposed to do in this case by treating the patient’s problem in her joint. Furthermore, the group this doctor practiced within was specialized around orthopedic and sports medicine, and was an extremely high volume practice. Counseling the patient on lifestyle changes, was not necessarily in his practice’s scope and might have been something a different clinician, like a physician assistant or nurse practitioner, might have done due to their education and training.
Many training programs for PAs and NPs cover topics of patient education and wellness, while physicians themselves are educated on the traditional Western medical practices that do not always cover wellness topics. As it is, health education for patients is a time-consuming process and for an overwhelmingly busy physician group is not a feasible undertaking. While health and wellness education to treating chronic conditions might be value-added for patients, it is not necessarily something the physicians have time for outside of their primary focus.
Thankfully, as technology enters the healthcare realm, there will continue to be resources available to patients to manage their own health. Providers can now also be armed with technology to effectively manage patient populations and improve the quality of time spent with patients. This means that not only do patients have the tools to educate themselves, but health care providers have more opportunity to engage and educate patients themselves. What is even more exciting is that this fantasy world of consistent, whole-patient care is not far off into the future and companies like CipherHealth have certainly been moving this idea closer to reality.
This post is a commentary written by our dedicated account manager, Kate Huber.