This is an updated post from my blogging days on Tumblr. It was very popular and I felt it deserved a bit of a revamp for my lovely WordPress home.
The benefits of exercise are widely known (and worth their own blog). We need to get everyone moving to improve the health of the nation. As a GP I feel a real responsibility to let patients know how exercise is a powerful tool for improving their health and well being. I’m still finding the best ways to do this.
The clock’s ticking
I have 10 minutes with every patient. In that time I have to establish why the patient has come, listen, ask questions, make a diagnosis and discuss treatment. Oh and I also have to advise them when to come back and type all the details into the computer. In most cases it’s not actually possible to do it in 10 minutes, well, not properly. Trying to squeeze in some health promotion and a discussion about exercise can be a real challenge. I’d like to hear your experiences of discussing exercise with your GP. Perhaps it has never been mentioned or perhaps you were inspired to start.
Brief interventions (this means a quick chat) from GPs have been proven to be very powerful. I’ve lost count of the number of times a patient has said to me “ Dr X told me I’d be dead in 5 years if I didn’t stop smoking and I haven’t touched a cigarette since”. Those quick warnings can really hit home and make a difference to some people. For them to be effective you really need to know your patient, it’s not appropriate to use a scare tactic for everyone, in fact it could be harmful, causing anxiety or offence. One size doesn’t fit all and knowing how to start the conversation effectively isn’t as easy at it sounds.
I’m fortunate, I work in a practice where most of the time you can get to see the same Dr for non-urgent problems. We’re proud of our continuity of care but I know that’s not the case everywhere. It can make health promotion really hard. It’s too easy to make a quick judgement about exercise and get it really wrong. Just because someone is overweight doesn’t mean they don’t do any exercise. You can be fat and fit. Take Julie Creffield the woman behind http://toofattorun.co.uk She runs marathons, she’s fit, but when she saw a locum GP and not her usual Dr with back pain he made a quick assumption. He assumed that her back pain was due to her being overweight. Julie says he told her she wasn’t fit enough to run a marathon. Thankfully Julie, being strong minded and confident, knew this wasn’t true although it did make her very angry. She’s not only continued running but gone on to enable, support and inspire other plus-size runners.
The dreaded question
I’m passionate about improving people’s health through exercise but it’s not always easy to know how to bring it up. Sometimes I feel like I’m nagging. I’ll ask people how much exercise they do and it’s similar to asking them how much alcohol they drink! Often they’ll look guiltily at the floor and mutter something about being a member of a gym….last year. If it’s a mum with a couple of toddlers in tow the responses vary hugely from raised eyebrows as if to say “What do YOU think?” to declarations of personal trainers and three Zumba classes a week. Some of my elderly patients are regular ballroom dancers and walking up mountains with their hiking groups. Some of my teenage patients don’t even walk into town and opt for the bus. You just never know what someone will say. I’ve learnt to ask and not to assume. I’m not asking so I can tell people off, just so I can congratulate them on what they do, make some suggestions and offer encouragement.
We need to do better
Exercise wasn’t prominent on the curriculum when I was at medical school, in fact I’m struggling to recall it ever being mentioned. Thankfully it is a topic that’s being addressed now and education is underway to educate our future Drs better. There’s still hundreds of Drs though who just know it’s good for them but struggle to pass that message on to their patients. Exercise health promotion is often an after thought when there’s only time for a quick “ You should do some exercise”. It’s not really helpful is it? It doesn’t really address the issues as to why people aren’t exercising. It’s not motivating or inspiring but it’s often the best we can do in the time we have.
I’d love to hear your views and experiences. How does it make you feel when you’re asked how much exercise you do? What exercise advice do you want from your GP? How do you feel about scare tactics? Is a quick comment from your GP better than no comment at all? Perhaps you think it isn’t the domain of the GP at all?
Leave your comment in the box below and let’s continue this important discussion.
Featured image supplied by Gratisography