Patient-centred consultations—clinicians can still do better

Dear Editor,

I read with great interest the article by Tremblett et al.¹ about what advice general practitioners give to obese patients to try and help them lose weight. As a medical student who recently received training about how to have such consultations during my general practice placement, I was surprised at the lack of effective methods to give advice that was used by the clinicians in this study. I believe that many of the lessons that I have learned this academic year can be related to the findings described in this article.

As detailed in the article, many clinicians lack the ‘knowledge and confidence on advice giving for weight-loss’.¹ However, even if clinicians had more knowledge on what advice to give, if the way in which they deliver this advice is sub-optimal, then the content of the advice matters less. Even simple and well-known ways to lose weight—such as reducing snacking behaviour and ensuring good portion control²—can be very effective pieces of advice if the clinician takes the time to explore the patient’s sense of importance or confidence in making these changes,³ and subsequently work with the patient to set realistic and achievable goals that are tailor-made to the patient. This approach heavily contrasts with some of the ways in which advice was delivered by clinicians in this study, which included clinicians providing ‘abstract advice without giving any reason, justification, or evidence’, with a lot of advice being ‘superficial’ and ‘not personalised to patients’.¹

In order to improve the effectiveness of primary care consultations with the aim of helping patients to lose weight, not only must the latest developments and research on weight loss strategies be made more readily available but also the importance of delivering ‘person-centred’ advice to patients must be emphasized. Strategies to do the latter could be delivered in the form of regular and appropriate refresher training for clinicians, as well as being heavily emphasized upstream (i.e. at medical schools). Such training could emphasize several strategies clinicians could utilize to deliver more personalized advice to patients. This could include clinicians making use of patient activation measures to determine how receptive patients will be to advice and delivering such advice accordingly; motivational interviewing using the ‘PAPA’ (Permission, Ask, Provide, Ask) and ‘OARS’ (Open-ended questions, Affirmation, Reflections, Summary) structures; scaling, whereby clinicians explore the importance and confidence patients have for implementing proposed lifestyle changes; and working collaboratively with the patient to set ‘SMART’ (Specific, Measurable, Appropriate, Realistic, Time-based’) goals,⁴ which allow patients to help tailor the doctor’s advice to their own lifestyles so that the resultant action plan is more practical and achievable.⁵

As the needs of an increasingly ageing population get more complex and patients increasingly require useful lifestyle advice on how to manage their long-term conditions, personalized advice delivered by clinicians in primary care will become one of the most important tools to reduce patient morbidity. Equipping and reminding clinicians of the simple strategies to deliver this advice is of paramount importance.

Funding

The study was funded by departmental resources.

Conflict of interest

None declared.

Data availability

There are no new data associated with this article.

References