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Primary care best equipped to improve patient behaviors


A troubling new study about the “unhealthy behaviors” of millions of Americans documented a reality that has increasingly become all too familiar to me and the 209,000 other primary care physicians in the United States-more than 25 million adults have at least three behaviors that inevitably lead to poor health.

Editor’s Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Glen Stream, MD, FAAFP, MBI, a family physician practicing in La Quinta, California, who is also past president of the American Academy of Family Physicians. He serves as the president and board chair of Family Medicine for America’s Health. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


Glen R. Stream, MDA troubling new study about the “unhealthy behaviors” of millions of Americans documented a reality that has increasingly become all too familiar to me and the 209,000 other primary care physicians in the United States-more than 25 million adults have at least three behaviors that inevitably lead to poor health.


More from Dr. Stream: Examining the resurgence of primary care


Because we stand at the vanguard of medical care, family doctors can’t help but see patients every day who smoke, drink too much, don’t get enough sleep, don’t exercise or are obese.

Sometimes all of the above.

The health consequences are not insignificant. The study, conducted by the United Health Foundation and released in partnership with Family Medicine for America’s Health, found that adults who report having three or more of five unhealthy behaviors are at more than six times as  great a risk of fair or poor health than those reporting none.

It gets worse for those reporting all five: an 8.5 times greater risk for heart disease and other chronic conditions linked to morbidity and mortality. Even adults who say they have only one unhealthy behavior are twice as likely to be at risk than those with none.


Blog: Change doesn't have to be a bad thing for physicians


While it may be common sense that more unhealthy behaviors add up to greater odds of poor health, this study is the first to quantify the impact. For me, it drives home just how important behavior is to health and should help those of us in  medical practice communicate more effectively with our patients about the risks to their health.

Next: PCPs to the rescue


Primary care doctors to the rescue

As family physicians, we’re in the best position in the healthcare universe to help the 72% of American adults with these behaviors. We know it because our calling, indeed our professional responsibility, is to manage all aspects of our patients’ health-mental and physical-and not just each in isolation.

That includes taking action to reduce the prevalence of unhealthy behaviors and motivate our patients to take better care of themselves.

ThI is nothing new. From the earliest days of our nation’s history, doctors serving rural and small-town America knew their patients well and cared for entire families, doing it all from treating illness to delivering babies and comforting the dying.


Blog: Who is ruining the healthcare system?


In urban America, primary care is no less important today than it was then. Margaret Chan, MD, director-general of the World Health Organization (WHO), underscored the point when, in a speech in 2013, she said, “a health system where primary care is the backbone and family doctors are the bedrock delivers the best health outcomes, at the lowest cost and with the greatest user satisfaction.”

Yes, Chan acknowledged, we need specialists and hospitals, but we “must also have primary care doctors who care about prevention…doctors who know their patients long enough and well enough to truly manage the totality of health in all its multiple dimensions, including mental and spiritual needs.”

For far too long, America’s healthcare system has been woefully out of balance-a system too often driven by volume over value.

Next: Changing the trend for the better


Changing the trend for the better

To reverse the trend, we need to build a system with the single-minded focus on improving patient health and increasing access to primary care. Improved access will help solve many, if not most, of our nation’s healthcare problems by helping people live longer and healthier lives and by delivering better quality at a lower cost.


Blog: Reexamining the 80-hour medical resident workweek


Just by increasing the number of primary care physicians, studies suggest we can save more than 127,000 lives a year in the U.S., because in places around the country where there are more primary care providers per capita, death rates for cancer, heart disease and stroke are lower and people are less likely to end up in the hospital.

In a sometimes-impersonal world, the role of primary care physicians in building a strong relationship with their patients has never been more essential.

To quote WHO’s Chan, family doctors are the human side of highly specialized and often dehumanized medical care-the “detectives” who do the work “that deepens the diagnosis to include the social and environmental causes of ill health” and are “our best hope for the future.”


Glen R. Stream is a family physician in La Quinta, CA and president of Family Medicine for America’s Health.

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