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November 1st, 2011

A Little Advice Goes a Long Way

Heidi Zook, MD

vitamin DIn an effort to get in shape, I decided to start working out with a personal trainer. Before the training sessions started, we met to talk about my general health. When it comes to health, I feel like I know what I’m doing — I’m a physician! Of course I know how to eat healthy and how to take care of myself (whether I choose to follow my own advice or not is another story). The discussion began with her asking whether I was taking any supplements. (A little background: I bought vitamin D supplements about a year ago, fully intending to take a daily dose. Unfortunately, the bottle is still nearly full.) The trainer advised me that vitamin D is beneficial in many ways and that I should be taking a daily vitamin D supplement. Did I already know that vitamin D offers multiple health benefits? Yes. Do I speak with patients routinely about their vitamin D intake? Yes. Do I strongly encourage my patients to take vitamin D? Yes. Did I start taking vitamin D daily only after my new trainer told me to do so? Yes. So, why did her telling me do to something I already know I should be doing get me to do it? That question doesn’t have such a straightforward answer. It seems ridiculous; I knew better than that! I guess the important thing is that she got me to do it, along with several other healthy behaviors that she reminded me about.

The idea of counseling in the clinical setting always seemed a bit redundant to me; I mean, who DOESN’T know that smoking leads to cancer, heart disease, and emphysema? Undergoing counseling myself with my trainer made me realize the power of instruction. When something is directed at you personally, and it’s coming from someone who is knowledgeable on the subject, it truly is powerful. This idea is reflected in a recent summary in Journal Watch General Medicine, “Counseling Can Encourage Intake of Cholesterol-Lowering Foods” (Oct 1, p. 153). Simple dietary counseling on two occasions led to a 13% reduction in mean LDL cholesterol levels compared with only a 3% reduction in the placebo group. Even better: the researchers found no significant difference in LDL reduction in the group who were counseled seven times versus the group who were counseled only twice. This article, along with my own experience, helped me reflect on what I can offer my patients: A little advice goes a long way.

4 Responses to “A Little Advice Goes a Long Way”

  1. Hamayun says:

    I suppose not all counseling is the same. I have heard friends complain about their doctor telling them that they need to get their pap smear, stop smoking, and eat more healthy. “I know i’m supposed to do that, but hate having to be reminded of it, and have it re-explained to me every-time i go in.” This perspective made me a little hesitant now, before I advise my patients. Perhaps I should gauge insight and see if there’s been self-assessment before I begin to educate my patients (although that would take a lot longer, and add more steps to the counseling session).

    hn

    • Heidi says:

      Very interesting and important perspective; something to consider and certainly a good example of how expectations differ among patients and why different approaches works with different patients. Thanks for sharing.

  2. L Fazen says:

    This blog just scratches the surface of Vit D use or overuse. Does the trainer advise people about blood levels, sun exposure, different dosages, and differences with age groups? It would be helpful for the bloggers to include references/expert opinion on Vit D for the interested readers.
    The blog was much more complete on the idea of dietary counseling but I guess I was still thinking of Vit D.

    • Heidi says:

      Thanks for the feedback. The bit about vitamin D was more of a personal story, with the focus being on the importance of clinical counseling in general and in reference to the article.

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