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The sixty seconds summary did not point out similar research showing that the time needed to treat chronic diseases according to NICE guidance using pharmaceutical approaches is similar (if not greater) in time requirements than that for lifestyle “advice”. It is unhelpful and likely incorrect to suggest that lifestyle advice is more time consuming for clinicians than pharmaceutical based care. For example, Reynolds et al estimated in 2018 (1) that for an average GP list of 2,500 patients, treating the 10 most common chronic diseases according to NICE guidance would require 10.6 hours a day.
It is worth noting that supporting people with lifestyle medicine approaches (which doesn’t just involve simple advice) to chronic disease has the potential to be more sustainable by reducing inappropriate prescribing which results in consultations due to side effects, titration needs, medication reviews, blood test monitoring and more; a cycle of ever increasing interventions. Whereas a lifestyle medicine approach, as taught by the British Society of Lifestyle Medicine (2), includes supported self-care, coaching, group clinics, social prescribing and deprescribing where appropriate. This discipline aims to achieve remission of chronic diseases where possible - surely a much more effective approach that doesn’t lead to exponentially increasing medical interventions?
It would be useful to evaluate a lifestyle medicine approach for time needed to treat over a year - in my experience this approach can be time intensive initially but results in time saving over the medium term as people become activated and supported to achieve the goals they want rather than simply increasing polypharmacy.
1. Reynolds, R., Dennis, S., Hasan, I. et al. A systematic review of chronic disease management interventions in primary care. BMC Fam Pract 19, 11 (2018). https://doi.org/10.1186/s12875-017-0692-3
2. Www.bslm.org.uk
If we reckon on 15 mins per consultation, a family doctor with 2500 patients would spend 7.4 hours per day to deliver all recommended preventive care and 10.6 hrs per day to deliver all recommended chronic care. Sorry I don't have the reference for this, a few years since I read it.
This leaves a generous 6 hours every day for those pesky acutely ill patients, sick certs, insurance and passport forms, paperwork, eating, sleeping, banging our heads against the wall in sheer frustration, toileting and reproducing.
Re: Sixty seconds on . . . lifestyle advice
Dear Editor,
The sixty seconds summary did not point out similar research showing that the time needed to treat chronic diseases according to NICE guidance using pharmaceutical approaches is similar (if not greater) in time requirements than that for lifestyle “advice”. It is unhelpful and likely incorrect to suggest that lifestyle advice is more time consuming for clinicians than pharmaceutical based care. For example, Reynolds et al estimated in 2018 (1) that for an average GP list of 2,500 patients, treating the 10 most common chronic diseases according to NICE guidance would require 10.6 hours a day.
It is worth noting that supporting people with lifestyle medicine approaches (which doesn’t just involve simple advice) to chronic disease has the potential to be more sustainable by reducing inappropriate prescribing which results in consultations due to side effects, titration needs, medication reviews, blood test monitoring and more; a cycle of ever increasing interventions. Whereas a lifestyle medicine approach, as taught by the British Society of Lifestyle Medicine (2), includes supported self-care, coaching, group clinics, social prescribing and deprescribing where appropriate. This discipline aims to achieve remission of chronic diseases where possible - surely a much more effective approach that doesn’t lead to exponentially increasing medical interventions?
It would be useful to evaluate a lifestyle medicine approach for time needed to treat over a year - in my experience this approach can be time intensive initially but results in time saving over the medium term as people become activated and supported to achieve the goals they want rather than simply increasing polypharmacy.
1. Reynolds, R., Dennis, S., Hasan, I. et al. A systematic review of chronic disease management interventions in primary care. BMC Fam Pract 19, 11 (2018). https://doi.org/10.1186/s12875-017-0692-3
2. Www.bslm.org.uk
Competing interests: No competing interests