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Healthy living is a hard sell- time to redesign the shop


Doctors set difficult challenges:

  • Eat a lot less
  • Exercise a lot more
  • Stop smoking
  • Drink less
  • Take tablets twice a day
  • Reduce salt

This takes effort and the reason you need to do any of it is because your bad habits have consequences. What is worse is that you may not recognise that you have a problem. You might say to yourself:

It’s not THAT bad.

Everyone in my family /neighbourhood looks like this.

I drink less than my mates.

I like salt, it makes my food taste better.

I won’t remember to take the tablets every day

It’s not like retail- you see something, you like it, the assistant treats you like royalty in a very pleasant environment,  you take out your credit card- that’s it. And there’s also the pay nothing-till- February deal. To please the doctor your habits must change. These habits are reinforced by cued-up behaviour on happy-making dopaminergic pathways. Research has repeatedly reproduced these results:

A sample of Norwegian adults (N=1579) responded to a self-administered questionnaire about seafood consumption habits, past frequency of seafood consumption, and attitude towards and intention to eat seafood. Structural equation modelling revealed that past behaviour and habit, rather than attitudes, were found to explain differences in intention, indicating that forming intention does not necessarily have to be reasoned. The results also indicated that when a strong habit is present, the expression of an intention might be guided by the salience of past behaviour rather than by attitudes. Honkanen et al

You might not see that doctor any time soon. The triggers to the behaviours that you need to change act when you least want them. What’s worse is that some of these triggers may not be obvious to you. You might find yourself chomping on sweets while you watch television. You might crave biscuits with your hourly cup of tea. You might watch television or stop for cups of tea because you are bored or stressed. The problem may not be the sugary snack but the boredom or the way you perceive your current life situation. Recognising that and dealing with is the real challenge. The boredom may be related to the mind numbing job that pays the bills in these ‘hard times’.

Doctors cannot possibly achieve behaviour change simply by pointing out that we are fat or drink too much.

If we conceive of a significant value of  primary care as something that promotes health doctors need to be able to sell the benefits of healthy living so that the patient considers them a priority. Something they wish to do even though it may hurt. It means creating an experience that will impact on the patient’s deepest psychological self. Can we do it from the current base?

  • An office style centre with boring notices and last year’s magazines.
  • Short consultations (ultra short in areas of greatest need).
  • Ineffective communication in uninspiring surroundings.

What can doctors do to change this experience so that the patient is tempted to act? Can what they promote, not to say sell, be made more appealing? According to psychologist we ‘buy’ things because:

  • We think it will make us secure
  • We think it will make us happy
  • We are more susceptible to advertising than we believe
  • We are hoping to impress other people
  • We are jealous of people who own more
  • We are trying to compensate for our deficiencies
  • We are more selfish than we like to admit

Therefore how can health promotion be designed with such an audience in mind? We need to consider every aspect of the experience doctors now provide. It’s not like selling gym membership or  widescreen television. It is about persuading people to make a persistent effort, to forge new habits and to invest in all sort of ways for a future they can’t immediately experience. We know from retailing that:

The …emotional responses induced by the store environment can affect the time and money that consumers spend in the store. Donovan et al

People can be triggered to make instant decisions. But what about decisions that involve a real commitment to change? Small change perhaps but change nonetheless which may lead to smoking cessation. If we look to the future of health innovation then we might learn from experts who have already managed to change our response to the world we inhabit by working out the art and science of triggering.

Picture by Gerard Stolk

Practitioner income as a function of Freakonomics

According to headlines this year more than one in three GPs in Australia report feeling somewhat or very dissatisfied with their income. Two things determine health practitioner income:

  1. What is a (funder / government / insurer) willing to pay?
  2. What is a (patient / customer / client) willing to contribute?

What is beyond doubt is that when it comes to their pet’s healthcare the Australian public is very willing to pay. In fact Australians would alter their spending habits rather than compromise their pet’s quality of life.

Of the 2,500 Australians, aged between 18 and 65 that were surveyed in the 2015 Financial Health Barometer, only 14 per cent of pet owners would reduce spending on their pets if their income dropped Remarkably, almost half (48 per cent) of respondents would take steps to minimise their power usage. We’d be more likely to reduce spending on essentials (47 per cent), switch to using cheaper products (35 per cent) or look for additional work (16 per cent) rather than curb spending on our furry friends. Hayley Williams.

Similarly spending on beauty treatments is remarkable:

The online survey of close to 1300 Australian women was conducted by Galaxy Research and commissioned by at-home hair removal brand Veet.
And, while 10 per cent of the women surveyed spent $5000 on average and and almost 60 hours in the beauty salon annually, 40 per cent admitted to putting their beauty regimens ahead of sleeping, shopping and their social life, with 4 per cent of those women also choosing a salon visit over their sex lives.

In contrast national statistics document that a significant proportion of Australians are reticent to seek healthcare because of the perceived cost. It was not surprising that a proposed $7 co-payment proposal for general practitioner visits in Australia was dumped before it was enacted.  It is evident that some doctors get paid far more than others. Secondly some parts of the country attract more doctors but as a general rule where there is a scarcity, by dint of geography or specialisation, it is more likely that doctors will earn more.

What people are willing to pay for health care is a function of economics, or perhaps “Freaknonomics” (study of economics based on the principle of incentives.) From this perspective “incentives matter.” Consumers try to maximize total satisfaction, while providers try to maximize profits. Whenever there are a lot of people willing and able to perform a job, that job doesn’t pay well. In a capitalist society, intense competition will drive prices down. When a technological advance occurs, it results in a shift of the supply curve to the right. All other things equal, this will lower the equilibrium price of a good, which then increases demand. Both producers and consumers need to be fully informed regarding their consumption or production decisions for a market to be efficient.

So how might this apply to primary care? 

  1. There are more doctors per head of population than ever before- in other words more people willing and able to perform the job- especially in primary care.
  2. There is a global trend in developed economies for “alternative providers” for primary care services- including vaccination, cancer screening and treatment of ‘minor’ illnesses.
  3. Technology offers new ways to ‘consult’ a practitioner other than by having practitioner and patient in the same room.
  4. Because of the internet doctors no longer hold the monopoly on information.

So doctors’ incomes in primary care experience downward pressure because suppliers of the services are increasing. We might therefore consider what people would consider paying for a consultation at a doctors’ clinic. Research published in 2008 (Annals of Fam Med) offers one perspective:

  • Overall, patients were willing to pay the most for a thorough physical examination ($40.87).
  • The next most valued attributes of care were seeing a physician who knew them well ($12.18),
  • Seeing a physician with a friendly manner ($8.50),
  • Having a reduction in waiting time of 1 day ($7.22), and
  • Having flexibility of appointment times ($6.71).
  • Patients placed similar value on the different aspects of patient-centered care ($12.06–$14.82).

It seems that two sectors (Pets and Beauty) appear to have no difficulty with their income. What might they have to offer by way of advice?

  1. The art of creating added value starts with the ability to see your business through the eyes of your customers.
  2. Although the debate over whether the customer is always right (or not!) continues, lack of customer satisfaction is a sure-fire way to keep people from coming back.
  3. Implement marketing models into your strategy.
  4. Most importantly, memorable customer experience models aim to deliver unexpected intangible value that cannot be packaged or sold. This includes personalized service, attention to detail, and showing a sense of urgency to address concerns as they arise.
  5. Whether it’s a free guide, a printable PDF, or a company branded calendar, free resources are a great way to create added value and showcase your brand’s ability to offer ‘a little something extra’ to customers.

In the case of healthcare the ‘customer’ is not just the patient but also the pay master. These ideas may need to be translated for this sector. In many cases it probably already has been. However for others there is something to learn from how successful businesses add value that translate into better rewards.

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Why doctors say ‘it depends’.

She looked harassed. She flung herself into the chair.

I’ve just about had enough. This cold is driving me mad. I’m coughing all day. Nothing helps. I’m still working for that pig of a man and we are short staffed this winter. I’m not sleeping at night. The kids are all down with this bug and my husband is on night shift. I can’t go on like this.

She left with a prescription for amoxycillin and a seven-day course of hypnotics. She also agreed to come back the following week to report on her progress. The consultation included a conversation about the natural history of viral illnesses and advice to defer the antibiotics, a discussion about her job as a reluctant telemarketer who left school without any qualifications and how to promote restful sleep. The only part of the consult that could be easily audited were the prescription data. The ‘real’ issue was not a microbe it was the milieu.

It is possible to publish papers in prestigious journals demonstrating that clinicians deviate from the evidence base. The list of misdemeanours is not insubstantial:

If you were a clinician you might say:

I never do that.

In which case you might reasonably be asked to outline your goals for consultations. If we accept that it is to be celebrated that people are free to make choices good or bad then we must accept that people smoke, eat more than they need, work in occupations that make them miserable or under bosses who are tyrants. They may choose to remain in abusive relationships or be addicted to drugs, alcohol, pornography or gambling. They are free to make choices but they must also live with the consequences of those choices. Eventually in most cases people will consider alternatives. The role of the clinician is to try to make that sooner rather than later whilst keeping channels of communication open.

The clinician advocates for the patient. In which case the answer to the question ‘would you do this’ is more likely to be:

It depends on the circumstances

You aim ‘never’ to cause harm. To avoid that which will diminish the patient’s choices by engendering physical or psychological adverse outcomes. Technological medicine can and does harm. However what is seldom reported is how the practitioners of the art of medicine help people to cope with life, not just today or tomorrow but in the longer term. That precludes slavery to ‘evidence’ that was never indicated for the very specific circumstances in which a person presents on one occasion. Compassion is not weakness. There is a narrative behind decisions in practice and simply reporting data does not present the whole story.

Picture by Vishweshwar Saran Singh

Cases too complex for a specialism other than general practice

It was a Friday evening. It’s almost always a Friday when this sort of case presents. She was in most ways unremarkable. She smiled readily, wasn’t evidently confused and worked in a senior administrative role. She came after work. This was the story:

I have a pain in my shoulder that becomes intense in my left arm pit. I can hardly bear to touch my arm pit. My hand becomes numb and cold. Today it’s so bad I’m finding it hard to turn the steering wheel.

I had 15 mins to sort this out, no scans, no blood tests, no discussion with a ‘team’ of young doctors working to pass their exams. She was describing symptoms that may have indicated a neurological emergency. And yet none of it made sense. She hadn’t fallen or been involved in any other trauma. There was no rash, no swelling. She swung her left arm over her head without any difficulty. I could not detect neurological signs, reflexes were normal. No Horner’s syndrome. No breast lesion. No obvious sensory loss. Twenty minutes later I could find nothing in her records or in her presentation that gave me any clue to the cause of these symptoms. And yet she was clearly worried. Regardless of the outcome I had to achieve one thing- this person like every other person who seeks help from a general practitioner needed to know that she had been taken seriously. Not for us the option of sending her back to whence she came with a note:

No organic pathology. Refer elsewhere.

A number of possibilities came to mind. Top of the list was ‘brachial plexus neuropathy‘ or Thoracic Outlet Syndrome. There were no objective signs at the time of presentation and I had never seen this before albeit that I had read about it sometime while at medical school. But then that’s primary care. We are the first port of call for anyone entering the healthcare system and often they present too early for anything to have manifested objectively. Not for us the text book presentation. About this diagnosis we know that:

Damage to the brachial plexus usually results from direct injury. Other common causes of damage to the brachial plexus include:

  • Birth trauma.
  • Injury from stretching.
  • Pressure from tumours.
  • Damage from radiation therapy.

Brachial plexus neuropathy may also be associated with:

  • Birth defects.
  • Exposure to toxins.
  • Inflammatory conditions.
  • Immune system issues.

There are also numerous cases in which no direct cause can be identified.

We also know that:

Signs and symptoms of thoracic outlet syndrome vary from patient to patient due to the location of nerve and/or vessel involvement. Symptoms range from mild pain and sensory changes to limb threatening complications in severe cases. Physiopedia

Diagnosis is difficult, tests and examination can be normalprognosis is variable. By the time a diagnosis was made weeks later and she presented to a specialist everything was obvious. But on that Friday evening with a surgery full of patients I was on my own. My patient trusted that I would not let her walk out of there only to lose a limb. Assuming a benign cause she would be back and need more. This was the start of a longterm relationship and how I managed this episode would set the tone for the duration.

While improvement may begin in one to two months, complete functional recovery may not be achieved for up to three years or longer in some cases. Tsairis et al

Picture by Mahree Modesto

An illness is never minor when you’re ill

After 20 years in practice I’d never seen one of these in my career. Until that day. It’s called a quinsy. Essentially an abscess deep in the throat. Not really surprising because according to a recent review:

Most patients with quinsy develop the condition rapidly, and many do not present with a respiratory tract infection to their GP first. BJGP

The incidence is estimated to range from 10-41 cases per 100,000 per year. It’s unusual to see a case in practice. Given Australia’s 23 million people you’d expect an incidence of about 2,300 cases per year nationwide. Similarly I consulted a young child with nephrotic syndrome, similar incidence (3.6 per 100,000). Both cases were referred to hospital as emergencies. The odds of seeing one of these is in the same order of magnitude as being struck by lightening in your lifetime.

On the other hand in the same week I saw several people with:

I also saw a victim of domestic violence:

Just under half a million Australian women reported that they had experienced physical or sexual violence or sexual assault in the past 12 months. Domestic violence prevention centre.

And a drug seeker:

Australian GPs write more than 15 million prescriptions per year for drugs known to be misused, with the main prescription drugs misused currently being narcotic analgesics and benzodiazepines, as well as stimulants, barbiturates and other sedative–hypnotic agents. Martyres et al

So apart from quinsy and nephrotic syndrome (both of which I recognised) I spent most of my week managing conditions that didn’t need to be referred to specialists.  And yet the people who were offered reassurance or simple and effective treatment for their ailments were immensely grateful. Every day general practitioners provide this service to the community. They save lives by identifying people who need urgent care but much more than that they make the lives of the community so much more tolerable. There is no such thing as ‘minor illness’.

The last word has to be on pityriasis rosea:

I finally found out what the rashes on my back, arms, torso, and now my foot are. I have herolds patch too. I hate it! I can’t stop scratching. It took 1 hospital visit and a trip to my doctor to find out what this thing was. The doctor at the hospital thought the big round patch was a ringworm and he thought all the other small rashes that had just appeared was scabies. I was terrified..did some research on scabies and tried to treat that myself. Then I decided to just go to my doctor and he told me it wasn’t scabies…and showed me a picture of hereld’s patch. He knew what it was right off the bat. I guess there is no cure for it and it just goes away by itself. I just wish I could take something so I can stop scratching. SkinCell forum

Picture by Col.Sanders

Who are you and what do you do for a living?

It was a dangerous time to be a forklift driver. One day I saw four of them each reported gastroenteritis. Now recovering but not fit to go to work. Or so they said. They were not related in any way, not even working in the same place and each had been poisoned by their spouse with something different: pizza, meat pies or lasagne. So either the partners of forklift drivers were terrible cooks or there was something else going on.

In April Wynne-Jones and Dunn reported data on sickness certification in the UK in the BMJ open. Their conclusion caught my eye:

Rates of sickness certification for back pain demonstrated a downward trend between 2000 and 2010. While the reasons for this are not transparent, it may be related to changing beliefs around working with back pain.

They try to explain their findings but then point out the main deficiency of their research:

This data set is based in one area of the UK, North Staffordshire, and it could be argued that it is not generalisable to the rest of the population. Previous work with this data set has demonstrated that crude rates of certification change very little when the data are standardised to the age and gender of the population as a whole, and there is no indication that this should be any different for this study

I scoured the paper for what might explain the findings because I couldn’t accept their thesis. I didn’t find what I was looking for. So I searched the unemployment statistics for the West Midlands in the UK dataset. As it happens the unemployment rate in that part of the UK, which includes Staffordshire varies quite significantly from the rest of the UK. When you plot the unemployment rates versus sick certification for low back pain the picture tells a different story:

Untitled

As unemployment rates climb from 2007 and peak during the Global Financial Crisis in 2009 the sickness certification for low back pain drops and plateaus. From the perspective of the General Practitioner patients are less likely to request sick certification when jobs are scarce. I was more inclined to accept the results of research by Michelle Foley and colleagues writing in the European Journal of General Practice in 2012 having interviewed GPs in Ireland:

GPs can find their role as certifier problematic, and a source of conflict during the consultation process with patients. GPs were concerned with breaching patient confidentiality and in particular disclosing illness to employers. They reported feeling inadequate in dealing with some cases requesting sickness leave, including certification for adverse social circumstances. Sickness certification was often given in response to patient demand. GPs felt a need for better communication between themselves, employers and relevant government departments

A few things struck me at the end of these visits to the library:

  1. Often the research that is most likely to impact on general practice is published in  so-called low impact journals. Often these are not randomised control trials or reviews of large databases.
  2. When interpreting ‘data’ we really need those who have regular contact with patients in the field to draw conclusions based on experience.
  3. The first question to ask a patient isn’t ‘tell me about your symptoms?’ but who are you and what do you do for a living?

For some people forklift driving is not a preferred way to earn a living but while there are options for alternative jobs ‘sick days’ may offer some respite.

Picture by bighornplateau1

Are we allowing technology to hamper healing?

13866052723_2020820f89_zYou’ve heard it before

I’m at that age doctor when I should have a full body scan. Like it’s being offered here.

or at the very least

Can I have a scan doctor?

When offered radiological tests immediately the public is led to believe that such investigations are necessary. In Australia between 1996 and 2010, total CT scan numbers have increased almost 3 fold. (Medicare Australia, Group Statistics Reports 2010, Report No. 2. Available from here). The number of CT scans is reportedly growing at about 9% each year in Australia. In the USA there are estimated to be 62 million scans per year as compared with about 3 million in 1980 with growing concern about the wisdom of exposing people to increasing levels of radiation.

At the same time the value of most tests carried out is also in doubt. In a study of an academic medical department it was concluded that:

…almost 68% of the laboratory tests commonly ordered…. could have been avoided, without any adverse effect on patient management; this figure corresponds to 2.01 unnecessary tests ordered/patient during each day of their hospitalisation. Miyakis et al

In the context of hospital medicine inappropriate test ordering adds to the cost of healthcare. In primary care there is the additional concern that tests fail to achieve any useful outcome. The patient may experience considerable dissatisfaction with the failure of diagnostic tests to explain their pain and may feel they they are being labelled a malingerer.

Therefore one might pause to reflect before requesting yet another investigation. Physical examination, which arguably obviates the need for many tests has an enormous value to the patient even in the context of advanced cancer.

Most patients (83%) indicated that the overall experience of being examined was highly positive (median score, 4; interquartile range [IQR], 2-5; P ≤ .0001). Patients valued both the pragmatic aspects (median score, 5; IQR, 4-5) and symbolic aspects (median score, 4; IQR, 4-5) of the physical examination. Increasing age was independently associated with a more positive perception of the physical examination (odds ratio, 1.07 per year; 95% confidence interval, 1.02-1.12 per year; P = .01). Kadakia et al

According to Paul Little and colleagues reporting in the BMJ perceived pressure from patients is a strong independent predictor of whether doctors examine, prescribe, refer, or investigate in primary care. It seems, at least in part that we may be responding to such pressures to order necessary tests. On the other hand our perception of the value of examination may be blunted.  As Professor Little wrote:

The doctors thought, however, there was no or only slight medical need among a significant proportion of those examined (89/580, 15%), given a prescription (74/394, 19%), or referred (27/125, 22%) and among almost half of those investigated (99/216, 46%).

One could argue with the doctors’ impressions of the ‘need’ for medical examination. To some extent it is necessary in every case. We may be losing the sight of the therapeutic effect of the examination as part of effective communication in primary care. There is a need to revitalise our ability to heal. At a time of increasing costs in healthcare examining patients is a relatively low cost intervention with significant potential to improve outcomes.

Picture by COM SALUD

Profiting from vanity- they may be targeting someone you love.

Where I live you’d be forgiven for thinking that you will be reported for child abuse if your teenager has less than perfectly straight teeth. Kids are growing up believing they need to be physically perfect.  So when the first crop of zits appears there is a hasty and often expensive trip to the chemist. Treating acne is a $3 billion industry in the United States alone.

..but i just feel so ugly when i see pretty girls with perfect skin around me.. it just makes me feel terribly disgusting, honestly. like i’m less of a person. it’s not fair. at my age there’s so much pressure to look beautiful constantly. even though i know most people don’t care how good you look a lot of them are secretly judging inside… everyone does it, even me..Nyla

Those in the age group 15-24 account for 7.6%  of consultations in general practice. Significant or life limiting pathology is unlikely in this age group but for many these meetings with their doctor will set the tone for a life long relationship with their main healthcare provider. For young people acne and eczema are the reason for almost one in three consultations with a GP. Sadly it has been reported that some teenagers get a very poor deal when they pluck up the courage to see a doctor:

It’s not that he doesn’t listen … sometimes he doesn’t fully comprehend that he’s talking in a way you can’t understand … it would help if they talked to teenagers. ( As reported by Jacobson et al in the BJGP)

This could be a missed opportunity to forge a relationship with the patient. If you are a doctor it may be worthwhile rehearsing a lucid explanation of common problems presented to you, including and especially acne. There is a bewildering array of opinions on this problem. Indeed the conclusion of research on this topic was that the majority of young people are getting information from non physician sources and there may be a need to evaluate the resources they are using to make sure they are receiving appropriate, helpful information. That includes parents who would rather their teenager would learn to live with her spots and expect you to endorse that view.

For those who want a ‘cure’ the opportunity for to profit from their distress makes them vulnerable to the most unscrupulous practices. $3 billion USD represents a substantial market for lotions, potions and diets that don’t work.

Substantial numbers of those surveyed had ideas about cause, treatment, and prognosis that might adversely affect therapy. Rasmussen and Smith

The truth is acne is a manageable condition, it’s just a matter of finding a treatment that works for an individual. For most people, it may take few attempts at find something that works. For some, over-the-counter topical creams are fine, for others, oral antibiotics or hormonal treatments work better, and yet others only respond to drugs prescribed by a dermatologist, with multiple courses required in relatively rare circumstances. The goal of having clear (or at least totally acceptable) skin is not unreasonable. This is a teachable moment in the interaction with young people.

Picture by Caitlin Regan

How can medicine compete against the new normal?

Joanna was exactly the person we are being urged to help. In her forties, overweight verging on obese. Hypertensive, asymptomatic but well on her way to chronic diseases. We discussed her diet.

I like salt. So my food tends to be salty. Also most people in my house are my size. I thought about reducing my portions but I like meat, lots of meat. I’m a member of a gym but I rarely go there.

We talked about her risk of heart disease and encouraged her to banish the salt cellar from the table, perhaps think again about reducing the portion size and making time to go to the gym. She looked at me pityingly her eyes said

Well that ain’t gonna happen

This was not a teachable moment. She was not ready to make an investment in changing her habits. She could not see that she was at risk. She was ‘normal’ as far as she could see. So she was not going to change her diet to deal with a problem that she did not perceive as real.

There are many things that are regarded as ‘normal’.

It is now normal:

  1. To have to wear extra large clothes.
  2. To be offered larger portion sizes when we dine out
  3. For more than one in three Australians aged 14 years and over to consume alcohol on a weekly basis
  4. For friends or acquaintances to be the most likely sources of alcohol for 12–17 year olds (45.4%), with parents being the second most likely source (29.3%)
  5. For more than one in three Australians aged 14 years and over to have used cannabis one or more times in their life
  6. For more one in ten people to drink and drive
  7. For one in three people to lose their virginity before the age of 16 ( i.e. before the age of consent) and also to have multiple partners
  8. For 66 percent of all men and 41 percent of women to view pornography at least once a month, and that an estimated 50 percent of internet traffic is sex-related.
  9. For most people who join a gym to never use it

These and many other trends dictate what is ‘normal’ to the average person. It’s OK to eat and drink far too much because everyone else does. It’s OK to be promiscuous, watch pornography and take risks because that’s what people see happening all around them.

Against these trends the challenge is to seek opportunities when ‘normal’ is seen as risky and hopefully before that risk has manifested as pathology.

Picture by Mario Antonio Pean Zapat

Tailoring lifestyle advice as per patient experience design

16821469876_8d062d433d_zLots of people stop smoking every time the tax on cigarettes is raised. It has been said that:

‘A 10% increase in the price of cigarettes in developed countries will result in a 3 to 5% reduction in overall cigarette consumption.’

And in one study only 6% of people were confirmed as non-smokers one year after receiving advice in general practice.

So if we can dissuade enough people from compromising their health with financial disincentives what is the role of the doctor and primary care? What can a health professional do to help when a smoker with a nasty cough seeks advice, and or treatment? It could be argued that the person is aware that their habit has a bearing on the symptoms. Or that by drawing attention to the link with cigarette smoking that the doctor is heightening a sense of shame, self-loathing and guilt.

So what is the role of general practice or primary care in tackling the big issues —smoking, obesity and alcohol abuse? Are brief interventions delivered in this setting more harmful than necessary? What if innovations delivered by practitioners were even more effective than the modest 6% recorded in the past?

An innovation that I was involved in evaluating led to one in seven smokers quitting. An innovation we subsequently developed as an adjunct to the treatment of obesity may well be more effective than diet and exercise regimens used alone. However if these innovations are delivered in a primary care setting then there is a risk that some patients who access them might feel challenged by the having it drawn to their attention that their results are a reflection of their own efforts. Those who fail to achieve the desired results may become disheartened.

It takes an effort to give up a harmful habit and it is now possible to predict and demonstrate the results of our lifestyle choices in ways that appear to matter to us the most. The key for innovators in the’ patient experience design’ space is to ensure that we minimise the harm that could be done by ensuring that such innovations do what they say on the tin and that they are designed with safeguards. What is beyond dispute is that the prevalence of obesity is increasing at an unprecedented rate and every health care professional has a role in combating this issue, not just those with a public health perspective. Some people respond best to health messages that are tailored to their personal circumstances, and as healthcare practitioners, we have a duty to make those options available to them. If you are interested in staying abreast of innovations developed along these lines click here.

Picture by GotCedit