I am a great believer in constantly encouraging people to be more active. My strategy is to tell patients to take a 20-minute walk in the morning – that can be to work, around the block, up the escalators – and another before their evening meal.
That is not asking a lot and it makes a significant difference to their health. Combine that with a healthy diet and a moderate amount of alcohol, and being a non-smoker, and not gaining weight, and they can reduce their risk of diabetes by about 90% and heart disease by about 70%.
I think we need to remember that doctors are very powerful. People do trust us and respect the advice we give. We dish out a lot of pills, but we forget that it is not about what we give, but how we give it. Giving lifestyle advice is something we should be doing.
It shouldn’t too much time, because it is just a question in the same way we ask patients about smoking and we know that repeated brief interventions have been really helpful in helping people to stop smoking.
A repeated brief intervention by everyone the patient comes into contact with can be effective – the practice nurse, healthcare assistant, GP, hospital doctors. If everyone says: ‘You should be doing something every day’. It can be something like a brisk walk for 20 or 30 minutes, it doesn’t need to mean going to a gym, putting on a tracksuit, breaking sweat.
Not all GPs will agree, but I think that this should be included in QOF. Most GPs only have 10-minute appointments, so asking them to do one extra thing may just be the straw that breaks the camel’s back. But we are the patients’ carers, and I think this is a very important thing to ask. If it were in the QOF than GPs would not feel they are being asked to do something for nothing.
Professor Mike Kirby is a GP in Radlett and professor of medicine at the University of Hertfordshire