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Evidence has shown that intervention by GPs can have a significant effect on patients’ attitudes to a change to a healthier lifestyle. If we are to have an impact on improving the health of the community, we must encourage our patients to take responsibility for their own health and thus change to a healthier lifestyle. They must be supported, however, by a caring doctor who follows the same guidelines and maintains a continuing interest. Examples include modifying diet, cessation of smoking, reduction of alcohol intake and undertaking exercise.
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In an American survey of 360 patients, 90% reported wanting a pamphlet at some or all of their office visits. Overall, 67% reported reading or looking through and saving pamphlets received, 30% read or looked through them and then threw them away, and only 2% threw them away without review. Only 11% of males and 26% of females reported ever asking a doctor for pamphlets. More patients desired pamphlets than received them.7
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Patient education materials have been shown to have a beneficial effect. Giving patients a hand-out about tetanus increased the rate of immunisation against tetanus among adults threefold.8 An education booklet on back pain for patients reduced the number of consultations made by patients over the following year and 84% said that they found it useful.9 Providing systematic patient education on cough significantly changed the behaviour of patients to follow practice guidelines and did not result in patients delaying consultation when they had a cough lasting longer than 3 weeks or one with ‘serious’ symptoms.10
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One form of patient education is giving hand-outs (either prepared or printed from a computer at the time of the consultation) to the patient as an adjunct to the verbal explanation which, it must be emphasised, is more important than the printed hand-out.
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The patient education leaflets should be in non-technical language and focus on the key points of the illness or problem. The objectives are to improve the quality of care, reduce costs and encourage a greater input by patients in the management of their own illness. In modern society where informed consent and better education about health and disease is expected, this information is very helpful from a medicolegal viewpoint.
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The author has produced a book called Patient Education, which has a one-page summary of each of 345 common medical conditions.11 The concept is to photocopy the relevant problem or preventive advice and hand it to the patient or relative. Over the years the greatest demand (following a survey of requests for prints of the sheets) has been for the following (in order):
exercises for your lower back (see FIG. 7.2)
backache
exercises for your neck
your painful neck
exercises for your knee
breastfeeding and milk supply
how to lower cholesterol
breast self-examination
testicular self-examination
vaginal thrush
menopause
anxiety
coping with stress
depression
bereavement
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Summary
Recommended target areas for health promotion in general practice include:
nutrition
weight control
substance abuse and control
– smoking
– alcohol
– other drugs
exercise practices
appropriate sleep, rest and recreation
safe sexual practices
promotion of self-esteem and personal growth
stress management
Important health promotion recommendations are to encourage patients to:12,13
cease smoking
reduce alcohol intake to safe levels (for healthy men and women, no more than two standard drinks per day and no more than four standard drinks on any single occasion; young people under 15 years should avoid drinking and young people aged 15–17 years should delay drinking for as long as possible; when pregnant or breastfeeding, no alcohol is the safest option)
limit caffeine intake to three drinks per day
increase regular physical activity (at least 30 minutes per day for 3 days per week, sufficient to produce a sweat)
reduce fasting plasma cholesterol to 4.0 mmol/L or less
have a diastolic BP of less than 85 mmHg
have a BMI of between 20 and 25 (see CHAPTER 9)
reduce fat, refined sugar and salt intake in all food
increase dietary fibre to 30 g/day
build up a circle of friends who offer emotional support
express their feelings rather than suppress them
discuss their problems regularly with another person
work continuously to improve their relationships with people
not drive a car when angry, upset or after drinking
follow cervical cancer screening guidelines
practise safe sex
have an HIV antibody check before entering a relationship