Baneful behaviors: a checklist for clinicians

Baneful behaviors: a checklist for clinicians – Editorial

Rodman Wilson

Although physicians are keenly aware that bad habits threaten the health of their patients, most physicians do not systematically talk to their patients about dangerous lifestyles.[1-4] Two reasons why this is unfortunate are: (1) Patients expect physicians to advise them about behavior[5] and (2) physicians can influence their patients’ behavior for the better.[6]

Half of the 2 million deaths in the nation each year are caused by destructive patterns of behavior.[7] A long life without disability is closely related to good health practices and the extent of contact with one’s family, friends and social groups.[8]

Physicians are in a good position to influence behavior because patients, as a rule, voluntarily seek their services and tend to believe and act on their advice. This is especially true if the physician respects the patient, is empathetic and nonjudgmental, listens attentively and analytically, and speaks in unambiguous, nontechnical language.

Of course, more than advice from the physician is usually needed to change behavior, but the process begins when the subject is broached. Even if a physician’s rate of success in inducing a patient, for example, to give up drinking alcohol or to use seat belts is low, the number of successes add up nationwide to be many.

It is particularly important to review stress, anger, domestic turmoil and depression with patients. The level of stress often lessens when a person talks about it with his or her physician. Anger can often be appropriately channeled, household violence is sometimes defused by talking to a third party (the physician) about it, and depression can be treated.

We have created a checklist for clinicians to use when reviewing dangerous habits with patients. The checklist contains 14 areas of personal behavior that clinicians should discuss from time to time with their patients. It takes from 10 to 30 minutes to complete. The examples for opening sentences and questions are worded so as not to embarrass or alarm the patient. Words may be modified to fit the circumstances. For example, one does not query a 70-year-old woman in the same way as one might question an adolescent. Dialogue after the initial gambit depends, of course, on the verbal and nonverbal responses of the patient. The checklist may be used by any clinician who is prepared to handle the answers to the questions.

* Tobacco “Do you smoke or use tobacco in any other way? Are you aware of the effects of tobacco on your health?”

* Alcohol “Many people drink. What are your habits regarding alcohol use?”

* Illicit Drugs “Many people do not realize that even occasional use of drugs like marijuana, cocaine, heroin and amphetamines can have a significant effect on a person’s behavior. If you have a problem in this area, let’s talk about it.”

* Seat Belts “Do you use your seat belt? Always? Do you insist that your passengers, including children, buckle up? Are you aware that even in cars equipped with air bags you still need to fasten your seat belt?”

* Speeding “Would you describe yourself as an aggressive or a conservative driver? Have you ever gotten a ticket for speeding? Do you find yourself driving fast when you are tired, angry, upset or frustrated?”

* Sexual Practices “Do you have more than one sexual partner? What do you know about safe sex?”

* Stress “Stress can be harmful if it is constant and especially if it comes from many directions, like problems at home, pressure at work, not enough money, and there is no place to get away from it all from time to time. What are the major stresses in your life right now?”

* Anger “How do you deal with anger? Do you get angry more often than you used to? Are you afraid at times that you will lose control of yourself?”

* Domestic Violence “In your home, do people throw things or hit each other? If so, does alcohol sometimes enter into it?”

* Depression “Are you lonely or sad? What kind of support do you get from other people? Do you ever have the feeling for days and weeks on end that life is not worth living–that you have lost control over your life? Has the thought of suicide ever entered your mind?”

* Home Safety “Do you have smoke detectors in your home? Do you check and replace the batteries regularly? Do you have grab bars in your bathroom? Is the tap water in your home so hot that it might burn you?”

* Guns “Guns and children don’t mix. How safe are the guns in your home?”

* Exercise “Do you find time for exercise? Regularly? Occasionally? What activity do you prefer?”

* Diet “Do you eat breakfast? What percentage of your diet do you think is fat? How often do you overeat?”

Taking the time to ask patients about these baneful behaviors may open a discussion that will help the patient adopt a more healthful lifestyle.


[1.] Orleans CT, George LK, Houpt JL, Brodie KH. Health promotion in primary care: a survey of U.S. family practitioners. Prev Med 1985;14:636-47. [2.] Freeman SH. Health promotion talk in family practice encounters. Soc Sci Med 1987;25:961-6. [3.] Lewis CE, Freeman HE. The sexual history-taking and counseling practices of primary care physicians. West J Med 1987;147:165 7. [4.] Sugg NK, Inui T. Primary care physicians’ response to domestic violence. Opening Pandora’s box. JAMA 1992;267:3157-60. [5.] Price JH, Desmond SM, Losh DP. Patients’ expectations of the family physician in health promotion. Am J Prev Med 1991;7:33-9. [6.] U.S. Preventive Services Task Force. Guide to clinical preventive services: an assessment of 169 interventions. Baltimore: Williams & Wilkins, 1989. [7.] McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993;270:Z07-12. [8.] Breslow L, Breslow N. Health practices and disability: some evidence from Alameda County. Prev Med 1993;22:86-95.

Dr. Wilson practiced internal medicine in Anchorage from 1958 to 1982, then was director of public health for Anchorage until 1987. He is now retired. Dr. Alberts is a psychiatrist in private practice in Anchorage and was once public health director for Wyoming.

COPYRIGHT 1996 American Academy of Family Physicians

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