Today’s post is a little different from some of my others – today I’m asking you, the readers to tell me what you think. There is no right or wrong answer to this problem but I’d be keen to know how other paramedics and student paramedics have tackled the problem and what their thoughts are.
Chronic disease. It’s what we do. I know that we all signed up intending to treat people who had suffered horrendous trauma or massive cardiac events, and sometimes we do. However it’s relatively rare. The vast majority of our time and effort is spent on treating people who have long-standing disease of the chronic Western variety. We’re usually attending because of an exacerbation of an existing problem and our treatment, combined with the hospital’s, is aimed at reducing symptoms enough for the patient to return home. It’s not glamorous but it’s a large part of our job.
It’s no secret that chronic disease is usually caused by or contributed to by lifestyle factors. I personally hate that phrase because it implies that there’s no autonomy involved, as if you didn’t choose the diabetes life, the diabetes life chose you. But it’s the one in general use so we just have to understand that “lifestyle factors” means eating sugary junk, doing no exercise, drinking to excess and smoking. There’s a mountain of evidence out there that these are exactly the behaviours you want to avoid if you want to live a a long and healthy life. One estimate that I read indicated that the total burden of disease caused by smoking is equivalent to the healthcare benefit provided by the entirety of modern medicine. * Amazing.
Knowing this, what can we as ambos do? Are we, as notionally emergency healthcare providers, in a position to be giving advice and trying to change people’s behaviour? Is it even possible? After all, when people get to the stage of calling an ambulance they’re usually pretty far down the road of disease progression and changing behaviours may not cause any significant improvement. Also, badgering the elderly non-English-speaking patient about their chocolate habit makes you look (and feel) like a jerk.
On the other hand perhaps we have an ethical obligation to at least suggest the issue? There is plenty of research to indicate that physician advice to cease smoking has a measurable effect.** Perhaps this effect is cumulative and an ambo providing their two cents improves the outcome? In any event given that we are healthcare providers treating medical problems, are we not obliged to provide lifestyle advice as part of our treatment?
I’m torn between these two options. I sometimes bring it up with patients but usually only if they’re young enough to benefit and receptive to my advice. My preference is a person in their thirties or forties who has some kind of probably-not-cardiac chest pain and who is spooked already. In that setting I find that they are usually receptive to a gentle suggestion, chiefly because they are highly motivated due to fear of death and because they already know what they need to do. Lose 20 kilos. Stop smoking. Go for a walk. They’re not stupid, they just need a push.
So what do you, the reader, do in this situation? Are you a softly-softly type who doesn’t want to rock the boat and possibly destroy your professional relationship? Or are you in people’s faces about their bad habits and bugger the consequences? I’m all ears.
* Burch, Druin. Taking the Medicine: A Short History of Medicine’s Beautiful Idea, and our Difficulty Swallowing It, Random House 2009.
** Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000165. DOI: 10.1002/14651858.CD000165.pub4.