Tales From the Trenches

TCTMD collected anonymous stories from physicians and other healthcare providers about their experiences prescribing exercise. Here is a sample of their responses.

“A couple years ago, I had an obese patient in the office and I said, ‘What does your doctor tell you for diet for weight loss and working on weight?’ And he said, ‘He never brings it up.’ I said, ‘I can’t believe that you go to a primary care physician that doesn’t ever bring it up.’ So the next time I saw that primary care physician in the hospital, I said, ‘Hey I saw one of your patients and he says you never even talk to him about obesity or losing weight.’ He said, ‘Hell no, I never talk to him about any of that. You know what happens when you talk to him about any of that? You waste 10 minutes of your time, and they walk out pissed off.’ That’s the mentality.”

“We have cardiac rehab for people who suffer myocardial infarction. Some of the doctors that I’ve talked to around here are like, ‘I don’t even know how to do that. I don’t know how to prescribe or recommend someone to go seek a cardiac rehab specialist.’ . . . It was just striking to me, like, shouldn’t you know how to do that? . . . Cardiac referral rates are really low. You always wonder what are the barriers, why are referrals not happening, why aren’t people attending, and maybe physicians don’t know the process and the steps to go about doing so."

“One of our physicians is very good at prescribing cardiac rehab, and the other ones don’t as routinely prescribe some of it. It could be old habit and changing routine. It wasn’t something that they started in their early practice, and it wasn’t part of their habit. I think there’s a little bit of the fact that I’m younger than them that may play a role. I also do think that being a nurse brings in a little bit of a different element. I’m very open to interdisciplinary practice and using various resources. . . . I think I often do spend more time in general on education with the patient, and it’s not that the physicians don’t know that, but I also think the demands on their schedule may often be greater than mine. And so I have a little more freedom to talk about those things that perhaps they don’t.”

“There are a few patients who I’ve had a lot of success with what we might consider nontraditional forms of exercise. One lady hates walking or biking, but she likes to line dance. So we talked about is there a club or group you could join. She started line dancing several days a week, and she’s actually lost a lot of weight! . . . Just figure out what their interests are because if they are not enjoying it, it’s really hard to get them to maintain even if you can get them to initiate it.”

“I would say about half my colleagues in a large group practice of 30 or so just don’t prescribe it to patients. Whether they could in theory is moot, because they show they can’t, or just don’t for whatever reason do it in practice. I’d guess 70% do at least some exercise themselves and probably have at least rudimentary understanding of it.”

To read TCTMD’s feature story on the struggles healthcare providers face with prescribing exercise, click here.