People ask me what lifestyle medicine doctors do. I do give them the textbook answer :
Lifestyle medicine is a medical specialty that uses therapeutic lifestyle interventions as a primary modality to prevent and treat chronic conditions including,but not limited to, cardiovascular diseases, type 2 diabetes, and obesity. Lifestyle medicine certified clinicians are trained to apply evidence-based, whole-person, prescriptive lifestyle change to treat and, when used intensively, often put these conditions into remission. It’s really important to know that the causes of the chronic conditions are multifactorial (means more than one cause): genetics, where you live, access to care/cooking facilities/good food as well as behaviours. However, it’s important for health and quality of life to help people improve their health within the part that they do have control over. 80% of chronic illnesses are preventable. And if we think beyond the individual patient – it makes sense for crumbling healthcare systems. We are seeing pressured healthcare systems globally from these diseases, not just Ireland. Evidence says it works – but applying the six pillars of lifestyle medicine—a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections. – requires giving patients more time and support that just telling them to “eat healthy and get more steps in”.in a rushed consultation. Lifestyle medicine is not alternative medicine but the foundations of traditional medicine. Lifestyle medicine in Ireland includes GPs and other specialist doctors who have undergone certification in lifestyle medicine. It also includes other registered healthcare professionals including registered dietitians, psychologists, and physiotherapists who have also undergone certification.
So, this is what a day looks like as a doctor who set up a clinic dedicated to just lifestyle medicine:
I wake up early. Every day, not just clinic days. I don’t set an alarm because I have a 4 y.o. I make sure DH knows what dinner has been prepped in the fridge. I manage to get out of the house on-time only because our amazing child-minder,E. arrives around 7am and I catch the next bus into town. It’s a 5 minute walk from the 103 to the clinic on Pearse St. but it takes longer because I pass amazing coffee shops and I am unable to walk past all of them without stopping at some point.
Coffee in hand, I arrive in time to clinic to log-on for the day. I check clinic e-mail and “Jane”. Jane is a secure platform that allows the practice to work as direct care for patients: patients can book themselves, attend virtual appointments, view results, prescriptions, copy of the letter I send their GP, etc. I check emails, usually on health promotion activities or education; I’m involved in several groups including Irish Society for Lifestyle Medicine and I talk with other doctors about healthcare improvements.. I usually write a quick post for the blog that will also post later on social media. There are no groups running at the moment, so it will be one-on-one with my patients the rest of the day. I try to schedule my virtual appointments on Monday and see in-persons on Friday. I prefer in-person whenever it suits the patient.
The first appointment that morning was in the rooms. Sleep has been a problem for the patient but also generally in the family home. We work through a sleep assessment and management strategies. We agree to check-in virtually in 2 weeks to see what is working – or not.
Later that morning is a virtual (telemedicine) appointment. I always prefer to see patients in-person, but this patient is based in Donegal. This patient wants to add lifestyle changes to optimise fertility. I also suggest we link-in with an INDI-registered dietitian locally, and I’ll help her with that.
I try to leave the clinic for a short walk and pick-up a salad in town on lunch break. I’ll answer a few more emails or patient messages.
The appointment after lunch is a follow-up (virtual). The patient is at-risk for health complications from excess weight so has been making some changes to reduce blood pressure and reduce risk of diabetes.
Mid-afternoon is an appointment for medical advising. A patient is considering traveling abroad for treatment. They sent me the link ahead of time, so I’ve done some expert research for them on the evidence (They have great questions: Is this a good idea? Is the science real?), risks, and benefits and things to consider. Ultimately, it is always their own decision but they now have information from trusted sources to make an informed choice. Sometimes medical advising appointments are short and this specific. Other times, a patient has been on a long journey and just needs someone to sign post where they go next. Sometimes, a patient wants advice on their supplement use due to increasing costs.
Late afternoon most of my appointments many afternoons are new or follow-ups for patients on weight-loss journeys, but a few might also be for patients quitting smoking. This isn’t weight loss for beauty or image. Patients who are attending me to lose weight are here (in-person or virtually) to reduce health risks, not to “drop a dress size”. Some have started Saxenda or Ozempic and are looking for support with the lifestyle changes that go with starting that medication.
Some of those appointments are short 1:1 screenings for upcoming group appointments.
Before I leave the clinic, I finish and proofread all GP letters for all the patients seen so far. Some patients will need input from dietitians, physios, or social prescribers and I’ll do those letters, too. I usually try to make sure that the patient has access to their letters on their patient portal same-day. I’ll review any new referrals that have been sent in via email from GPs or specialists. Because this is a direct-care model, patients are very welcome to self-refer. It actually means more time during my day was spent with patients – whom I really like. It’s a 15-minute walk back to get the bus home and have time with my sons before their bedtime.
The rest of the Friday evening is mine, which is refreshing after years of clinical practice. And I go home knowing that I saw patients without long waiting lists and I was able to give them all the time they needed to tell their story. And they can get in touch with me if they need me. That is the best part. There is a doctor-patient relationship and a work-life balance.
0 Comments