Why Don’t Doctors Take a Lifestyle History?

By Michael A. Smith, MD

Sometime around the end of the first year or early in the second year, medical students learn how to conduct a medical history. This is literally one of the most important skills a young doctor will learn during training. A world-renowned doctor once told me that 90% of all diagnoses are made from a patient’s medical history. Sounds pretty important right?

Well, if it’s so important, why do doctors leave out a lifestyle and nutritional history? It’s true that they usually ask some basic questions like, “Do you drink, smoke or do drugs?” But that’s about it. Nothing is asked about diet, supplements, or exercise.

Now, I know all of you doctors out there are going to argue that you do ask about those things. No you don’t. And if you do, you probably aren't listening to or caring enough about the answers.

Here’s my point: If we’re serious about a paradigm shift in our approach to medicine — one from reactive medicine to proactive medicine — then it begins by teaching doctors how to conduct a lifestyle and nutritional history.

And since conventional doctors don’t know how to do this, that means that you, the consumer, will have to do the teaching. Print out the following questions and take them to your doctor. Tell them that asking these questions will help them to better understand their patients.

Overview of the Nutritional History

Taking a medical history is about telling a story. A thoughtful doctor will use the interview to create a picture or story about the patient. This is invaluable, not just for treating disease, but also for helping people live longer, healthier lives. But in order to accomplish all of this, the history needs to contain lifestyle and nutritional information.

A lifestyle and nutritional history should be routinely incorporated into the medical history. Doctors just have to make it a habit. For example, when asking about medications, physicians could also ask patients if they are taking any vitamins, minerals, laxatives, or other supplements.

Additionally, patients can be asked specific questions about their typical food intake. Although a variety of methods for obtaining a diet history are available, the following set of questions is designed to identify major sources of saturated fat, salt and sugar and give doctors an overall sense of their patient's eating habits.

Food & Drink – The Questions to Ask

Believe it or not, the following questions come from the American Association of Family Physicians. So what this tells us is that they know they should be asking these questions. So why aren’t they?

Here’s the first round of questions all doctors should ask:

  1. How many meals and snacks do you eat each day?
  2. How many times a week do you eat away from home?
  3. When eating out, what types of places do you frequently visit?
  4. On average, how many pieces of fruit do you eat each day?
  5. On average, how many servings of vegetables do you eat each day?
  6. On average, how many days a week do you eat a high fiber cereal?
  7. Do you eat white breads, pastas and rice?
  8. How many times a week do you eat white meat like chicken or turkey?
  9. How many times a week do you eat fish?
  10. How many times a week do you eat shellfish?
  11. How many times a week do you eat dessert?
  12. What do you consider to be a healthy snack?
  13. When do you eat the most food?
  14. Would you rather eat fried food, baked food or broiled food?
  15. Are you overweight or underweight?

Lifestyle – The Questions to Ask

Now let’s move on to lifestyle questions:

  1. How many hours of TV do you watch each day?
  2. How many times a week do you exercise for at least 30 minutes?
  3. How many days a week do you walk after a meal?
  4. How many hours a day do you sit at work?
  5. Are you active at work?
  6. What is your favorite weekend activity?
  7. When was the last time you went swimming, rode a bike or went hiking?
  8. How many hours do you sleep a night? Do you have problems sleeping? Do you snore?
  9. Do you catch a cold or get the flu each winter?
  10. How much sun do you get? Do you wear sunscreen?
  11. Do you own a pet?
  12. Are you more likely to wear tennis shoes, flip flops or formal shoes?
  13. Do you smoke?
  14. How often do you drink alcohol?
  15. What do you do when stressed out?

Supplements – The Questions to Ask

Finally, let’s talk about supplements. This is so important because it not only gives doctors information on how their patients supplement their diets, but also can clue them into the things their patients are concerned about.

For instance, a friend of mine was always asking me about electrolytes and minerals — like sodium, chloride, potassium and magnesium. Yet he always claimed everything was fine. One day at his house, I noticed he was taking a high dose mineral formula, in addition to his multivitamin.

So I asked him some direct questions about his health. Specifically, I asked him if he feels his heart skips beats — people with “jumpy” hearts usually link it to electrolytes. He became solemn and said “yes — and it’s scaring me.” He said he thought it might be due to low salts and minerals. So he decided to replenish them. Long story short, we got him the proper work-up and discovered he has atrial-fibrillation.

So here are some questions doctors can ask their patients about their supplement usage:

  1. Do you take supplements?
  2. Do you take them every day?
  3. Why do you take them?
  4. Do you take a multivitamin?
  5. Do you take fish oils or omega-3 products?
  6. Do you take CoQ10?
  7. Do you take digestive enzymes or probiotics?
  8. Do you take vitamin D and how much?
  9. Do you take supplements for _____________ ? (fill in with symptoms or diseases)

We Have to Start Somewhere…

There’s really only one way to improve our health and avert an economic health crisis in this country … proactive, preventative medicine. And it begins by teaching doctors how to conduct a lifestyle and nutritional history.

And this history isn’t just about collecting information; it’s also an opportunity to teach about the importance of diet, supplements, and exercise. It will place these important factors more at the forefront and not in the background.

Take a look at the questions again. What would you add to our list of questions? Will your doctor be open to receiving the list of questions?


LaPortaMA said...

1) You don't need to be a doctor to ask these questions. You just did it on paper.
2) these still barely touch upon the externals of lifestyle.
3) about diet, supplements, or exercise -- we're told to do so, but most don't; now why would that be?
4) Do you know what to do with the answers, doctor?
5) What % of patients want to be asked? Don't they already know their responsibility? Will they be open to advice?

Odd how many contradictions and hypocrisies persist, despite what appear to be best intentions.

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