The Article in Brief

The Art and Complexity of Primary Care Clinicians' Preventive Counseling Decisions: Obesity as a Case Study

Andrew L. Sussman , and colleagues

Background Counseling patients about preventing disease and staying healthy is an important part of primary care, but clinicians provide this type of counseling at low rates. In this study, researchers looked at factors that influence clinicians’ decisions to provide preventive health counseling. In particular, they focused on counseling patients for obesity.

What This Study Found The decision to provide preventive counseling for obesity is influenced by complex factors in 2 categories: (1) Factors that are fairly stable and unchanging, such as the clinician’s personal values, definitions of success, and the availability of community resources. These factors “set the stage” for the patient visit. (2) Factors that are more dynamic and changing, such as the patient’s agenda for the visit, how receptive the patient is to the proposed counseling, and the presence of special opportunities (“teachable moments”) for counseling. These factors vary with each patient visit.

Implications

• Efforts to increase rates of preventive counseling need to focus on the complexity of the primary care visit, rather than on a few isolated elements of the visit.
• Clinicians actively manage time during the brief patient visit to maximize the benefits to the patient. Efforts to increase rates of preventive counseling should consider the many competing demands faced by clinicians and patients during the course of a visit.