Lifestyle discussions during doctor-older patient interactions: The role of time in the medical encounter

Context: Although physician influence can be especially powerful with older adults, relatively little is known about how primary care physicians (PCPs) interact with their patients regarding lifestyle issues. Objective: To document the length of time that PCPs discuss lifestyle issues with their older patients and to examine patient, physician, and contextual correlates. Design: Descriptive and multivariate analysis of videotapes of physician-patient encounters. Setting: Medical encounters from 3 primary care ambulatory settings. Patients: There were 116 ongoing medical encounters with patients aged 65 years or older. Main outcome measures: Total time spent in physical activity (PA) discussions and total time spent discussing PA, nutrition, and smoking during the medical encounter. Results: Very little time was spent in lifestyle discussions. On average, PA was discussed for less than a minute (58.28 seconds) and nutrition for slightly less than 90 seconds (83.11 seconds). Only about 10% of the average 17-minute, 22-second encounter was spent on physical activity, nutrition, or smoking topics. Physician supportiveness score (beta = 8.92, P ≤ .001) and the number of topics discussed (beta = 106.39, P ≤ .001) were significantly correlated with the length of all lifestyle discussion. Lifestyle discussions were also more likely to occur during longer visits. Conclusion: There is a critical need for additional training of primary care providers on how to discuss lifestyle issues in the most time-efficient but effective manner to achieve positive behavior change associated with improved health outcomes. There is also a need for the institutionalization of policies to encourage more lifestyle discussions.