JAMA Physician Competencies for Prescribing Lifestyle Medicine
The July 14, 2010 issue of JAMA carried the result of a two year project initiated by the American College of Lifestyle Medicine (ACLM) to begin establishing standards in what was then the newly defined field of Lifestyle Medicine. The American College of Preventive Medicine (ACPM) led the organization and management of the project.
The publication, entitled Physician Competencies for Prescribing Lifestyle Medicine outlined recommended competencies for all physicians in addressing the lifestyle causes and treatments for most medical problems in modern society.
Blue Ribbon Panel Established Recommended Competencies
Composed of top level representatives from the American Medical Association (AMA), the American Osteopathic Association (AOA), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), the American Academy of Pediatrics (AAP), ACPM, ACLM, and individual national experts in nutrition, exercise, and Lifestyle Medicine that convened in Washington DC, July 2009, this Blue Ribbon Panel convened to garner competencies consensus.
This following Competencies outline is intended to provide a minimum guideline for all physicians—especially primary care physicians. Guidelines for Lifestyle Medicine Specialists are being established by the soon to be formed American Board of Lifestyle Medicine.
Lifestyle Medicine Physician Competencies
Definition: Lifestyle medicine is the evidence-based practice of helping individuals and families adopt and sustain healthy behaviors that affect health and quality of life. Examples of target patient behaviors include, but are not limited to, eliminating tobacco use, improving diet, increasing physical activity, and moderating alcohol consumption.
Values: Lifestyle practices and health habits are among the nation’s most important health determinants. Changing unhealthy behaviors is foundational to medical care, disease prevention, and health promotion. The physician’s trusted relationship with the patient, with the support of the family, an interdisciplinary team and the community, is key to improving health behaviors and outcomes.
A practicing primary care physician should possess the following knowledge, skills, attributes and values.
- Promote healthy behaviors as foundational to medical care, disease prevention, and health promotion.
- Seek to practice healthy behaviors and create school, work and home environments that support healthy behaviors.
- Demonstrate knowledge of the evidence that specific lifestyle changes can have a positive effect on patients’ health outcomes.
- Describe ways that physician engagement with patients and families can have a positive effect on patients’ health behaviors.
- Assess the social, psychological and biological predispositions of patients’ behaviors and the resulting health outcomes.
- Assess patient and family readiness, willingness, and ability to make health behavior changes.
- Perform a history and physical exam specific to lifestyle-related health status, including lifestyle ‘vital signs’ such as tobacco use, alcohol consumption, diet, physical activity, body mass index, stress level, sleep, and emotional well-being, and order and interpret tests to screen, diagnose and monitor lifestyle-related diseases.
Use of Office and Community Support
- Use nationally recognized practice guidelines (such as those for hypertension and smoking cessation) to assist patients in self-managing their health behaviors and lifestyles.
- Establish effective relationships with patients and families to effect and sustain behavioral change using evidence-based counseling methods and tools and follow up.
- Collaborate with patients and their families to develop evidence-based, achievable, specific, written action plans such as lifestyle prescriptions.
- Help patients manage and sustain healthy lifestyle practices, and refer patients to other health care professionals as needed for lifestyle-related conditions.UU
- Have the ability to practice in an interdisciplinary team of health care providers and support a team approach.
- Develop and apply office systems and practices to support lifestyle medical care including decision support technology.
- Measure processes and outcomes to improve quality of lifestyle interventions in individuals and groups of patients.
- Use appropriate community referral resources that support the implementation of healthy lifestyles.
AJLM Lifestyle Medicine Specialist Competencies
The Lifestyle Medicine Physician certification has been in place for several years. Although raising competence across all specialties through the Lifestyle Medicine Physician Diplomates to a foundational level is essential, additional expertise must be attained to be a true Lifestyle Medicine Specialist. This column will describe how Loma Linda University Health (LLUH) created a Lifestyle Medicine Specialist Fellowship that meets the educational pathway requirements for the Lifestyle Medicine Specialist certification and how it can be replicated and sustained at other training sites across the nation.