Behavior is the wild west of medicine
In 2010, I was getting ready to graduate from college and start medical school. I was excited for the a new challenge and confident that a career in medicine would be a way for me to make some small impact in the world. Medicine, it seemed, was the ideal way to help. And then I stumbled upon some data that really bothered me.
It came from a review article in the New England Journal of Medicine—the flagship journal for clinical research. Among other ideas, it revealed that healthcare plays only a minor role in preventing premature death. Behavior, it turns out, has a much bigger upside for preventing death than just about anything else we can do. And among causes of premature death linked to behavior, obesity and smoking are far and away the biggest opportunities to really make a difference. The actual delivery of healthcare is a fairly minor factor in how long people live.
Fortunately, most physicians get this. They know that behavior is important, and they try to talk with their patients about smoking cessation, exercise, diet, and illicit drug use. But we are still failing to move the needle in producing substantial behavioral change. Part of the reason for this is that many behaviors are really, really hard to change. Another reason is that evidence-based behavioral change therapies are few and far between—especially regarding obesity. Physicians also receive very little training about how behavior and its determinants should be approached. Likewise, their appointments tend to be shorter than they’d like them to be, preventing them from addressing every issue they want to cover. Some have even lost faith in behavioral change and focus their attention in a manner that reflects this. Whatever the problem may be, the evidence suggests that physicians have a long way to go in promoting better behavioral health.
Some might argue that it is the job of public health professionals and policy makers to address these issues. I agree wholeheartedly. These problems are complex enough to require a system-wide approach. However, I don’t think that the medical community can pass the buck onto others. We need to be at the forefront of the design and implementation of behavioral health strategies. Because realistically, helping patients to quit smoking, lose weight, and even just to take prescribed medicine may be the most important things that can be done in a routine doctor’s visit.
These challenges are tough. I don’t expect that we will find many easy solutions. But I do believe that discovery and implementation of effective, evidence-based behavioral change therapies is one of the most pressing concerns in medicine today.
Over the next few weeks, I’ll be looking into the literature to find out about therapies that actually do work for behavioral change. I’m planning to write about therapies for smoking cessation, obesity, alcoholism, medication compliance, opiate addiction, and motivational interviewing (I’m not going to make any promises about a particular order). Let me know if there is any other treatment that you are curious about.
Thanks for reading! I’d love to hear your thoughts here or on Twitter @jeffrey_g_clark. This post was originally published at EuthymicLabs.com.
