Top Challenges Number 7: Treating patients with chronic conditions

It has never been such a challenging time to be a physician. Every physician, whether they own their own practice or are employed by a hospital or larger health system, must navigate a host of obstacles each and every day: Payment hassles, staffing issues, patient communication obstacles, technology burdens, long hours and burnout, and much more. 

Each December, Medical Economics presents its list of the top challenges facing physicians going into the next year. This year we focused not only on the challenges, but also practical tips physicians can start using right away to make practicing easier.

Challenge 7: Treating patients with chronic conditons

Millions of Americans suffer from complex chronic conditions, which harms their quality of life and shortens their life expectancy while adding costs to the U.S. healthcare system, already the most expensive in the world.

Complex chronic conditions-such as diabetes, obesity, and other cardiometabolic disorders-are at the root of this problem, and often involve difficult treatment regimens that include medication and lifestyle changes. Treatment of these conditions typically falls to busy primary care physicians, who don’t have enough time to provide these patients with the counseling and life-coaching that treatment of these conditions often require. At the same time, physicians are financially judged on the health outcomes of these patients, leaving physicians in a bind.

At the heart of many of these chronic conditions is obesity. An estimated 39.8 percent of U.S. adults over 20 have obesity, with another 31.8 percent considered overweight, according to the 2015-2016 National Health and Nutrition Examination Survey. Obesity increases the risk for many medical issues, including hypertension, diabetes, sleep apnea, cardiac disease, arthritis, hyperlipidemia, and certain cancers. The U.S. spends approximately $190 billion annually, or 21 percent of healthcare dollars, on obesity and related conditions. 

“We need to start treating the largest disease in our country, as all other health issues go along with it,” says Craig Primack, MD, co-founder of the Scottsdale Weight Loss Center in Arizona. 

What can physicians do to better engage and reach these patients to encourage them to take control of their health? One popular technique is motivational interviewing, which allows physicians to learn what’s going on in their patients’ lives, what motivates them, and other factors. This can help physicians tailor their approach to each patient and find the triggers that motivate that individual, says Damara Gutnick, MD, an internist and the medical director of the Montefiore Hudson Valley Collaborative.

Gutnick uses the acronym CAPE to explain the basics of motivational interviewing:

Compassion. The entire interaction is driven by the best interest of the patient.

Acceptance and respecting autonomy. Individuals have the right to change or not change, says Gutnick. “If somebody is not ready, you respect that and you don’t push. You might use some skills to try to guide them toward change, but if you’re hearing a lot of resistance and you have four patients waiting, you don’t push [during] that visit,” she says.

Partnership. The physician is not telling the patient what to do. Instead, “You’re helping the patient move toward change, but you’re equals,” Gutnick says.

Evocation. This means pulling ideas for change out of the patient. “As a doctor, I know a lot of reasons why you should quit smoking, but only you know what’s most important to you,” Gutnick says. This mindset can help neutralize patients’ natural reflex to come up with reasons to not do something when it comes in the form of “doctor’s orders.”

The challenge for both physicians and patients is that both need to change their behavior. “Any behavior change is really hard,” Gutnick says. “People might have the desire, but if you don’t have the milieu that allows you to try it, then it’s going to be very hard to implement.”