Improve your management of cardiometabolic disorders

September 4, 2009

The art of medicine can be as pivotal as the science of medicine when it comes to managing the treatment regimens of patients with cardiometabolic disorders.

Key Points

Medical Economics spoke with a number of physicians and other healthcare providers about the many ways they educate their patients with cardiometabolic disorders. Though each physician has his or her own preferred modalities, they agree that successful patient education begins with you, the primary care physician. Following are their insights into ways you can use education to maximize the health of your patients.

KEEP IT PERSONAL AND POSITIVE

During a recent "heart-to-heart" visit, he employed this approach to encourage an obese patient to improve his diet. Rather than choosing high-fat meals at the fast food drive-through window, the man was encouraged by Hood's message to go hunting in the woods for the meat that he craved. The man followed Hood's recommendation-and lost nearly 40 pounds in three weeks.

"This shows that the individualized message is the most effective," says Hood.

David Spees, MD, a family physician with the 400-physician Sharp Rees-Stealy Medical Group in San Diego, California, also finds that the personal touch motivates patients to better care for themselves. That's why he provides handwritten lipid and blood pressure goal statements, each of which lists the patient's levels at the current office visit, what it was at the last visit, and what the goal is. If a patient's levels go in the wrong direction, Spees determines what went wrong, then works with the patient to get him back on track.

"I always positively reinforce my patients when they have a success, even if they're just thinking about moving along the decision curve to take action," says Spees.

Your own positive approach to motivating patients can empower them to make better choices, says Stephen W. Ponder, MD, FAAP, CDE, medical director of the South Texas Children's Diabetes and Endocrine Center at Driscoll Children's Hospital in Corpus Christi. Emphasizing positive reinforcement is vital to transforming long-term behaviors, he says, though many physicians overlook their tendency to provide subconscious negative reinforcement.

Motivation is a key tactic used by Iresha Goonesinghe, MD, FACP, FACC, an internist and cardiologist in Ridgecrest, California. Three-fourths of Goonesinghe's patients have cardiometabolic disorders, she says, and she sees 250 of them each month.

Goonesinghe spends considerable time learning about her patients' motivations and trying to resolve their social and emotional stressors. She then works with them in setting small, achievable lifestyle goals at each visit.

"I try to change, for example, what a patient might eat at one meal, rather than the whole diet, so the patient has a sense of achievement," she says. When that patient returns with news of her modest success, Goonesinghe builds upon it with positive reinforcement and encourages the patient to embrace a new increment of improvement.

Ken Gross, MD, an endocrinologist with the Polyclinic in Seattle, emphasizes health and not necessarily weight, and encourages patients to exercise and cut down on their calories and unhealthy foods.