Last week I discussed the prevalence of poor communication between doctors and patients and how it can compromise the quality of health care. Doctors can give the impression they are too busy, too preoccupied to really listen to what the patient has to say. And patients can mislead doctors, telling them what they think they want to hear instead of the truth, or they hide their feelings and say nothing. In other words, there is plenty of blame to go around, and both sides can contribute to poor communication.

This is especially the case when it comes to preventive medicine and the need to make lifestyle changes. Change is difficult, and changes in lifestyle can be the most challenging. For starters, there needs to be resolve and a firm commitment, and the role of the doctor can be the key to success. But this can put the doctor in a difficult position.

On the one hand, the doctor doesn’t want to make the patient worry or feel uncomfortable, or to scare the patient. This often leads to understatements, like “let’s start watching your weight,” or “your blood pressure is running a little high.” In addition, many doctors believe their words won’t have much impact on patients when it comes to lifestyle change, so they don’t pursue it.

In my opinion, doctors have much more influence than they realize if they are willing to take a firm stand. Unfortunately, the research in this area is a bit fuzzy. The reason is there are two factors operating. First, is the impact of the doctor’s words on the patient’s attitude and intentions. And, second, is the outcome.

If we separate the two, it’s possible that the doctor’s words are quite effective in stimulating the desire to change in the patient, but the patient fails to follow through. This means the doctor’s efforts are worthwhile, despite a failed outcome. And, who knows, when the seed is planted, there may be success in the future.

A strong message does the trick

Recently, I saw this play out quite clearly. A close friend (I’ll call him Fred) has had coronary artery bypass surgery, and other heart related issues. For years, his wife and I have tried in vain to encourage lifestyle changes in the form of a healthier diet and daily exercise, but he resists. As a result he has added considerable fat to his midsection, which makes his situation much worse due to the increased risk of Type 2 diabetes.

I explained the dangers of diabetes and the need to lose body fat as a long term measure, and taking a daily walk for an immediate positive effect. He always listens politely, nodding his head in agreement, but when I’m gone his wife tells me that he refuses to take walks with her.

I visited them in July and the conversation, as always, eventually got around to how Fred was doing. To my surprise, his wife piped up enthusiastically about Fred’s doctor. Finally, she said (with emphasis on “finally”), the doctor got very firm with Fred while going over his test results. In particular, Fred’s hemoglobin A1-C test was too high, which means Fred was moving quickly toward Type 2 diabetes unless he makes changes. “Trim your waistline,” the doctor told him, “and start exercising.” Then he explained why, and emphasized the dreadful consequences of diabetes. The doctor essentially repeated what I have been telling Fred, but the impact was remarkably different and, “Bingo,” Fred decided on the spot that he would shed some belly fat and take daily walks with his wife.

I looked at Fred’s wife, and we both laughed. No amount of effort on our part over the years could persuade Fred to take action, but a firm warning from his doctor did the trick.

The bottom line

It won’t always work to produce the desired outcome, of course, but I think in general, when a doctor is firm about the need to change, it catches a patient’s attention in a way that nothing else can.

Reach Bryant Stamford at

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