Patient-centred information and interventions: tools for lifestyle change? Consequences for medical education

Life style related risk factors have negative consequences for many health outcomes. Although preventive actions undertaken on a population level are effective, these actions do not reach the individuals who could benefit most. Family doctors could reach many of these individuals when they consult them for other reasons. Unfortunately time constraints and competing demands as well as the fact that many practising physicians have not been trained in patient-centred communication and life-style interventions interferes with optimal prevention in primary care. Patient centred approaches can be helpful in prevention. Placing the subject on the agenda of a consultation, followed by a discussion of risks and symptoms that is adjusted to the patients' context are a start. Information building on the patients' existing knowledge is more effective than information in general. Patients can be motivated towards change through discussions, and empowered to make necessary changes. Of the available effective patient centred approaches this article discusses the 'Stages of Change (Trans Theoretical) Model, motivational interviewing, problem solving and action planning, and demonstrates a combined approach using a family practice patient with a number of risk factors. Fortunately modern medical education does pay attention to patient centred communication in general. In order to have a positive impact on the health of populations, additional options for training in patient-centred techniques should become available in residency programmes, and in continuous medical education for those practicing physicians who are not yet trained in patient centred approaches.