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How can you add value as a family doctor?

Ninety percent of people will consult a family doctor in 2020. The graph on the left suggests why they will do so. A significant number will have minor self limiting illness, a larger proportion will have chronic/ long-term illness and most will attend for multiple reasons. The graph on right demonstrates that most people will have risk factors for long-term illness often more than one risk factor. To reduce the risk(s) they will need to change their lifestyle. The challenge in primary care is to add value by triggering/ prompting lifestyle change. That is a very specialist skill set. Mandates a new paradigm and or a new set of tools.

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Tame Your Advice Monster Doctor

Giving advice without considering the context or the receptivity to that advice may be akin to prescribing drugs without checking for potential drug interactions or allergies. At best it may be unhelpful and at worst it can cause harm.

In his book on ‘The Advice Trap’, Bungay Stanier asks us to consider the circumstances in which we are tempted to issue advice. There is a very helpful table on page 43 in which he outlines the type of person and the type of situation in which we are tempted. Doctor’s reading the book would clearly recognise the risk: Someone apparently seeking advice and time is short; someone who doesn’t ask for advice when there is a lot at stake; and someone who challenges you and ‘that thing’ keeps recurring.

What is the evidence that doctor’s advice to lose weight achieves any results? A startling conclusion from a recent study:

There were no significant interactions between Health Care Professional’s (HCP) advice and attempts to lose weight. Obese adult’s attempt to lose weight, and not HCP’s advice to lose weight, was a predictor for healthy eating behaviors. Interventions in medical practices should train HCPs on effective strategies for motivating obese patients to adopt healthier lifestyle

Preventive Medicine

The issue of health promotion needs to take account of the circumstances of people’s lives and the complexity of the aetiology of many such problems:

Social ecological models that describe the interactive characteristics of individuals and environments that underlie health outcomes have long been recommended to guide public health practice. The extent to which such recommendations have been applied in health promotion interventions, however, is unclear. The authors developed a coding system to identify the ecological levels that health promotion programs target and then applied this system to 157 intervention articles from the past 20 years of Health Education & Behavior. Overall, articles were more likely to describe interventions focused on individual and interpersonal characteristics, rather than institutional, community, or policy factors. Interventions that focused on certain topics (nutrition and physical activity) or occurred in particular settings (schools) more successfully adopted a social ecological approach. Health education theory, research, and training may need to be enhanced to better foster successful efforts to modify social and political environments to improve health.

Shelley D. Golden, MPH and Jo Anne L. Earp, ScD

You may enjoy my podcast with Michael Bungay Stanier

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Preparation is key to the consult in medicine

It may be helpful to consider what we know about anger in medical practice. you may also enjoy my conversation with Ron Epstein

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If you’re feeling grumpy, try this trick

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Most of what happens in medicine is talk

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Interview with Michael Bungay Stanier- author of the Coaching Habit is available here.

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Your choices in medicine make the greatest difference

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There are two actors in the medical consultation

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The Art of Doctoring published on Jan 10th 2020

The book is available on Amazon

Moyez Jiwa, an experienced and thoughtful doctor, elevates with practical brilliance the lovely work that clinicians do. In sharp contrast to the grayness of industrial healthcare, he reimagines doctoring as performance art and proposes an elegant script to respond carefully to the suffering of each person. Bravo!

Victor Montori. Professor of Medicine at the Mayo Clinic in Rochester, Minnesota, USA.

Dr. Moyez Jiwa has written a practical guide for medical professionals to make authentic connections with their patients –and in doing so, spark enduring behavior changes that translate into better outcomes and happier lives. The Art of Doctoring left me feeling hopeful for the future of health care in a world where this book is on every provider’s shelf.

Amy Bucher, Ph.D., author of Engaged: Designing for Behavior Change and Vice President of Behavior Change Design at Mad*Pow

Behavior change is a complex science. Clinicians who desire to have lasting positive impact in their patients’ lives must consider the context of the each patient’s life. Successful, sustained health behavior change is driven by the individual [i.e. patient] who is ready for change, and The Art of Doctoring is written with an awareness of the role each patient plays in his or her own journey of living. The Theatre Model© is a brilliant way to frame a patient-provider encounter: Individuals choose who they enroll on their [health care] “theater cast” and how much influence, or how much of a role, each cast member will have. In addition, Jiwa calls out the paramount need for the office encounter to evolve and for the recognition that the patient be seen as “the most important person in the clinical encounter”. There exists a need for a board-certified coaches on the health care teams of the near future!

Nicole M. Guerton, MS, MCHES®, NBC-HWC, CIFT Wellness Coach | Mayo Clinic Department of Medicine | Healthy Living Program Assistant Professor of Health Care Administration | Instructor of Family Medicine

In his book The Art of Doctoring, Professor Moyez Jiwa has unlocked the secrets to creating better experiences for patients as well as the doctors who care for them. In each chapter, he uses very relatable patient stories to illustrate the art of doctoring and uses The Theatre Model© to skillfully peel back the curtain of medicine to reveal the essence of what it really means to be more than simply a good doctor, but to connect with your patient as healer. With more that 30 years’ experience, Jiwa is a leading voice in healthcare. This book is a must-read for anyone on the journey to unite both the science and art of medicine to create a better human experience.

Jake Poore, President and Chief Experience Officer, Integrated Loyalty Systems, Inc.
13538 Village Park Drive, Suite 120, Orlando, FL, USA 32837

Sir William Osler said that the practice of medicine is, “An art based in science.” Dr. Jiwa puts this into action in his book, The Art of Doctoring. He artfully describes how science can best inform a therapeutic ceremony that can be intentionally put into place to facilitate health in those we serve. He uses the best of science to teach the art. And what a wonderful artist he is. Anyone interested in cultivating their own healing arts would benefit from the wisdom this writing shares. I highly recommend it.

David Rakel, MD, Professor & Chair, University of New Mexico Dept of Family & Community Medicine, Author of, The Compassionate Connection.

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Making a diagnosis as a family doctor

The fact that it is often difficult or perhaps impossible to correlate the pathology and symptoms of coronary artery disease has led to a great deal of discussion and numerous explanations have been proposed.

Fred M Smith

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Do it as you’d want to experience it yourself

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Jerald WINAKUR podcast here: https://www.journalofhealthdesign.com/JHD/podcasts/view/221

Randi Oster podcast here: https://www.journalofhealthdesign.com/JHD/podcasts/view/223

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