Chronic Disease Now Exceeds Acute Disease As The Reason For GP Visits
By Dr Michelle Reiss, GP & Lifestyle Medicine Physician
For many centuries medical treatment has been sought mostly for “acute” problems – “acute” implies an illness with trauma, pain, fever, or infection which requires an immediate diagnosis and treatment. Once correctly diagnosed, most “acute illnesses” settle spontaneously or can be fully treated with prescription medication or surgery, with return to normal functioning in a short period of time.
Now, for the first time in history, the prevalence of “chronic disease” has overtaken acute disease as the main reason why modern patients see a doctor. Chronic diseases are mostly caused by lifestyle factors, and over the last 30-40 years have risen in prevalence to account for approximately 70% of all primary health care visits in developed countries1.
Over the past 4 decades, with the rapid advancements in digital technology, manufacturing and processing, mankind has seen significant changes in food types, dietary patterns, daily activity levels and general lifestyle behaviours. Unfortunately, these rapid changes in diet and activity levels have contributed to an emergence of chronic diseases of pandemic proportions 2,3. The list is long and includes conditions such as Type 2 Diabetes, overweight/ obesity, high blood pressure, pre-Diabetes, high cholesterol, heart disease, chronic fatigue, emphysema, hip and knee joint pain, back pain, chronic stress and many forms of depression and anxiety.
The challenge is they do not make a person FEEL ill until they have progressed to a point where organs or mood starts to suffer or fail. Diagnosis is therefore delayed unless appropriate screening is in place. Unfortunately, they also cannot be fully cured with medication, so they exist indefinitely which is why they are termed “chronic” meaning “to persist for a long time or constantly recurring”.
The scary statistic is that these conditions now make up the top 5 causes of death in Australia for those in the over-45 age categories2
Today’s General Practitioners (GPs) are experts in managing both acute and the measurable parameters of chronic disease, such as blood pressure control or sugar control. Managing the CAUSE of chronic disease is different, and lies in addressing lifestyle choices and assisting behaviour modification.
In a standard GP practice setting, unfortunately, this remains problematic4: patients want a quick fix (even better if in pill-form!) and GP’s are well intended but time-poor and often uncomfortable to address the complexities of behaviour change…this high turnover, medication-focused approach severely affects the establishment of a deeper Doctor-Patient relationship that is required for behavioural change.
LIFESTYLE MEDICINE is the newest field of sub-specialisation in modern medicine. The specialty was named in 2008, and the field of practice has only gained worldwide momentum among GP’s and Allied Health Providers (such as physiotherapists or dieticians) over the past few years1. Lifestyle related health problems are PREVENTABLE and in many cases, REVERSIBLE, so as the name suggests, Lifestyle medicine addresses the “cause-of-the-cause” and can reverse early- to medium-onset chronic disease by assisting patients through evidence-based lifestyle guidelines and behaviour modification.
Lifestyle Medicine is an evidence-based approach that bridges the gap between the old and new, between medical knowledge and common sense and is the shining light at the end of a very dark chronic disease tunnel. It is defined as “the application of environmental, behavioural, medical and motivational principles to the management (including self care and self-management) of lifestyle-related health problems in a clinical and/or public health setting.”1
To me, however, the most beautiful aspect of this clinical specialty is that “it is inexpensive and even cost-saving; free of all but good side effects; safe and appropriate for children and octogenarians alike. It is, quite simply, the best medicine we’ve got.” 5.
As a Lifestyle Medicine physician I have learned, over time, that for anyone to maintain the motivation6 to make sustainable change, their “WHYs” and their “HOWs” have to be clearly defined. To this point, with regard to LM, I hope that I have clearly explained:
WHY you may want to understand the concept of Lifestyle Medicine.
WHY, although being evidenced-based conventional medicine, it differs in its approach to chronic disease.
WHY it addresses the real “cause-of the-cause”2,3 of chronic disease.
If you are a patient who would like to lose weight, change your lifestyle habits, prevent your chronic disease risk factors or reduce your chronic disease, then it is also important that you establish your “WHYs”. This means setting your vision and your goals. By knowing WHY you have set these goals you can clearly define your pathway to that goal.
Only once you’ve set your goal and know your pathway, then can you determine HOW best to follow that pathway.
In the next section I’d like to guide you on:
HOW to get Lifestyle Medicine from your Doctor or Allied Health Professional
HOW you could apply the principles of Lifestyle Medicine yourself to assist you in achieving your weight loss, risk factor reduction, disease reversal or overall wellness goals.
HOW you might like to frame your own health within the “Bio-Psychological-Social” framework of complete wellness.
How do you get Lifestyle Medicine from your GP or Allied Health Professional (AHP)?
In reality you do not actually “get” Lifestyle Medicine from your Health Care Professional (HCP) as you would a medication or surgical intervention. In Lifestyle Medicine, your GP or AHP acts as a “coach” and provides you with the education and the tools (the “Why’s” and the “How’s”) to travel the pathway to achieving your goal. You become the “driver”.
A GP, skilled in Lifestyle Medicine principles6, will:
Evaluate your personal level of readiness8 to make a lifestyle change.
Guide you towards forming an action plan9.
Assess your knowledge and confidence levels in applying change.
Help you address your motivation9 and any physical or psychological barriers to change.
Provide you with the latest in evidence-based information on diet10, exercise11, stress, sleep, tobacco risks, alcohol risks.
Should consider a multidisciplinary team of suitably qualified LM Allied Health Providers as part of your health care pathway.
Offer you ongoing non-judgemental support through all stages of your change process, through lapses and relapses and ongoing maintenance. Support could be through a combination of consultations, group programs, nurse visits, telephone contact, apps or social media connectedness.
So, if your GP provides you with the tools, how could you ensure that you steer yourself along your health pathway? Consider the following:
Are you really ready to make lifestyle changes?
Have you set a clear goal and “KNOW YOUR WHY”? Is your pathway to your goal defined for yourself? You can of course (and should) set smaller goals along the way.
Are you clear on “HOW” to follow the pathway to your goal?
Do you understand the difference between “Internal” and “External” motivation and how this impacts your chances of sustainable change?
Have you received assistance in evaluating your own “Self-talk” and how this may pose barriers along your pathway to your “forever change”?
Do you know how and where to get support, either through your Health Care Professional, friends, family, community groups or online?
As I explained in my introduction, Lifestyle Medicine is an emerging field and it may not be easy to find a GP or AHP that can apply all the principles of evidence-based information and couple that with support and behavioural change techniques. Rest assured, easier access is around the corner as the pandemic of Chronic Disease cries out for a different approach to medical care. And that approach is Lifestyle Medicine7.
References:
1. Garry J Egger, Andrew F Binns and Stephan R Rossner. “The emergence of ‘lifestyle medicine’ as a structured approach for management of chronic disease”: Med J Aust 2009; 190 (3): 143-145.
2. Australian Institute of Health and Welfare 2016 Australia’s health 2016. Australia’s health series no 13 September 2016. Canberra: AIHW.
3. Australian Government Department of Health. “Chronic conditions are the leading cause of illness, disability and death in Australia”. 16 May 2017
4. Liana Lianov, Mark Johnson. “Physician Competencies for Prescribing Lifestyle Medicine”: JAMA, July 14, 2010—Vol 304, No. 2, 202-203
5. David Katz, MD, MPH, FACPM, FACP, President, American College of Lifestyle Medicine, Founding Director, Yale-Griffin Prevention Research Center
6. RACGP. “Motivational interviewing techniques: Facilitating behaviour change in the general practice setting”. AFP, Volume 41, No.9, September 2012 Pages 660-667
7. https://www.lifestylemedicine.org.au
8. Prochaska, JO; Velicer, WF. “The transtheoretical model of health behavior change”. Am J Health Promot 1997 Sep–Oct;12(1):38–48
9. Miller WR, Rollnick S. Motivational Interviewing. Preparing people for change. 2nd edition. New York: The Guildford press, 2002.
10. Large studies showing benefits of mostly Plant-based diets: Lyon Diet Heart Study. Framingham Heart Study. Nurses Heart Study. Adventist Health Study 2.
11. Australian Government, Dept of Health. “Australia's Physical Activity and Sedentary Behaviour Guidelines”. Nov 2017.