Face is a mirror & for any physician his entry in the clinic with his free & smiling face offer & overall free & healthy sign even by watching the expression of physician even by watching the patient in the clinic .

Physician under a psychological bent of  mind which has been observed that when the patient enters before him , physician expression with a smiling note before the patient offers him first rate ready made medicine which keep the patient psychological happy & healthy .

Physician while explaining the particulars of patient ailments & even if he finds the complication of ailments , he will tackle his patient in such manner that psychological he will not be nervous & in quite good cases may help for the fast recovery in such cases .This is my personal opinion 

Thanks prof Parik!. Yes, physicians should be a models and representative of  healthy person. We say in spanish that  "We predicate what we do".

So, healthy Lifestyle promotion stars with healthy physicians who are promoting  it.

As in Nursing the self care of the health professional is paramount if you are to have a therapeutic presence with the client/patient. The new specialty of Integrative Nurse Coaching provides nurses with the skills to assist patients identify their needs, set their SMART goals and make lifestyle changes. Physicians don't have to do it all, but they can certainly identify & plant the seed & give recommendations & collaborate with the Nurse Coach to support patients in lifestyle change. I work in a Cardiology practice and am constantly  referred clients with cardiac risk factors amenable to lifestyle change. This is addressed via individual coaching sessions and/or group sessions. Clients are not billed in this practice as my part time salary is covered through a grant.

for further information on the International Nurse Coach Association see: http//inursecoach.com  

Direct clinical providers should be part of a larger continuum of care for the patient. Physicians do not necessarily have to develop their own educational programs, however, they should be connected to the people/organizations with the right expertise in order to refer patients.

Physicians often come to prescribe to the stereotype that patients are "non-compliant." This is the first attitude that must change. Although, it is not easy to change lifetime habits, physicians have a particular authority and respect with their patients that enable them to empower patients in ways that others cannot. Physicians must first believe that patients can change. Physician reimbursement incentives based on patient behavior change can also be motivational.

Second, physicians must be aware that social determinants are a powerful force in each patient's life. Physicians must gain a better understanding of social needs and know how to work within those constraints to effect behavioral and lifestyle change. For example, if a patient is food insecure or is struggling with housing, it will not be easy for the patient to adopt healthy eating for diabetes management. Physicians should adopt screening for social determinants (food insecurity, housing insecurity, intimate partner violence, etc.) in association with the medical history to determine how best to advise the patient and refer the patient to needed resources.

Third, screening for adverse childhood experiences and historical trauma may also be helpful. Complex trauma is associated with poor health outcomes across the lifespan. Simple awareness and education for both physicians and patients may reveal why negative health behaviors were developed and create a positive environment for change.

Fourth, the development of cultural competency skills will assist physicians in understanding patient lifestyle and connecting with patients on a deeper level that will enhance behavior change. Physicians can also marshal the resources of the family and social support networks to support the patient in behavior change. 

Thanks Profesor  Sotero for your specific  and  explicit comments!. All the physicians we should think about social  determinants and family social support. As we can see the clinical treatment of every patient should  be extended to the family and community.

As a physician with many years of experience I would say that even if the personal primary care physician would have enough time and tools to devote for this scope on an occasional visit of a patient - it is not the proper way to  talk about health promotion or education. The main approach should be to start health education in schools and to extend it along the years of life as a vibrant  and ongoing issue of public discussion. 

The best educational products incorporate input from the multitude of fields you reference.

On the more granular level (when the physician is seeing a patient), the literature shows that motivational interviewing techniques have been successfully taught to physicians and produced improved patient outcomes.

Hi Lori

Could you mention some references regarding  the improved patient outcomes .following training  interviewing techniques to their physicians .

I think the physicians must have knowledge about Public Health.

In order to obtain the goal, It´s important the participation of multi- disciplinary team, including : Social communicators.

It´s important to do educational interventions (applying different techniques) in order to improve Health Literacy of the population.

Best wishes.

Diana from Perú.

For Arthur....many other sources out there as well

Motivational interviewing: a systematic review and meta-analysis

Sune Rubak, Annelli Sandbæk, Torsten Lauritzen and Bo Christensen

Br J Gen Pract 2005; 55 (513): 305-312.

This is a  very interesting question. I am not a physician , but I have many of them as my friends. I teach PhD students health communication and some do their PhD works in disease prevention especially chronic diseases.Physicians tend to see a client as a biological entity. Yes, human beings are animals when looked from the perspectives of anatomy. However, what is especial about human beings is that we have the invincible energy that derives each of us to be what we are as human beings and as individuals. You may call it spiritual power or any other. Working with the biological characteristics of a client would not result in achieving  sustainable outcome. If a physician understands that the client has an invincible energy which decides his /her behavioral response to what the physician does, then working with the power of the patient/client would support or stimulate the patient to use his/her invincible energy for a positive action. Understanding what a patient/client likes and dislikes be it nutrition or any other is a way of recognizing the client as a person with power. If a physician helps his patient understand why certain practices are helpful for her/his health, then the patient is likely to use his energy   to make the suggested practice as his/her behavior. Empowering a patient is critical in dealing with illnesses and healing.

Physicians typically do not have the skills to design health education/promotion programs.  Nor should they.  Physicians should focus on the tasks for which they are the best to provide.  They should then refer their patients to those with the necessary expertise for other patient needs.  This may be someone else in their office/practice or it may be within another organization. They should also support policy change which will make it easier for their patients to make the needed changes.

This means that physicians need to learn what is available in their community.  What other professionals are available - health educators, physical activity specialists, dieticians, psychologists, policy specialists, teachers, business people, etc.  Then the physician needs to meet with them to find out how they can collaborate.  There are organizations which specialize in health promotion such as the community department of hospitals, health departments, schools, community centers, etc.  Learn about these organizations and refer patients to them.  There may be health promotion coalitions who work on policy issues such as tobacco or healthy eating.  Find out how you can become a part of the coalition and support their work.  It may be as simple as writing a letter to the editor of the newspaper or it may be providing testimony to the legislative body.

Arthur I agree with you. Physicians in many countries are under increasing pressure to spend less time with each patient. The opportunities for 'motivational interactions'  are unlikely. I feel the best way that physicians can contribute is through their professional associations to pressure, lobby government to introduce healthy public policy or to strengthen health systems.