Study: Doctors Underplay Role As Counselors

Doctors are more likely to counsel well-to-do patients than poor ones to lose weight and to exercise, and they more frequently tell poor patients to quit smoking, according to a study.

Regardless of the advice, poor patients are much more likely to heed it than are wealthier ones, said the study in today’s Journal of the American Medical Association.

Overall, doctors varied a lot in counseling patients to change unhealthy behavior, though such counseling can lead to change.

The study is based on a survey of 6,549 Massachusetts state employees in 12 health plans last year.

Only 73 percent of doctors discussed exercise, 70 percent discussed diet, 61 percent discussed stress, 53 percent discussed smoking, 39 percent discussed alcohol, 19 percent discussed safe sex and 16 percent discussed seat belts among patients the subjects pertained to.

The researchers speculate that poor patients may get less advice on diet and exercise because they tend to have more illnesses than the rich do and doctors may be devoting their time to more pressing matters. Also, doctors may underestimate their ability to persuade patients to change at all income levels.

The study was limited by omitting the wealthiest and poorest segments of society, researchers said. It also is based on less than a two-thirds response rate from the 10,733 workers queried.

Still, the findings suggest that, in general, physician counseling of patients regarding risky behaviors could be greatly improved, said researchers led by Dr. Deborah A. Taira of New England Medical Center.

A government task force urges doctors to counsel all patients when appropriate on cigarette and alcohol consumption, seat belts, diet, exercise, stress and sexual practices.