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Table 4 Attitude of GPs toward discussing lifestyle with patients: a typology of GPs

From: Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study

VISION Limited role of GP pertaining to the promotion of a healthy lifestyle. It is the task of the government to promote a healthy lifestyle. Reimbursement is a strong motivational factor for the delivering of intervention in general practice. Health promotion and prevention are part of the job of a GP. Although GPs state their consulting hours are more focused on treatment instead of prevention, they think it is worthwhile to spend time on health education and counselling. But in the end patients make their own choices. Self management among patients is very important in general practice. The PN has a central role to educate and counsel patients. The GP confirms the importance of healthy lifestyle and supports progress of behaviour change of patients. The general practice carries out a lot of lifestyle programs. However the GP is sometimes sceptical about the effects. Nevertheless, they are sure that they can help at least some patients. GP discusses lifestyle even if the patient has no related symptoms. They confront their patients with their unhealthy lifestyle. These GPs have a lot of lifestyle programs in general practice. The role of the GP is like the role of a teacher/ educator or nurturer. GP’s have to educate their patients.
The GP imposes standards of a healthy lifestyle also to his/her own life, to set a good example.
QUOTES ‘Those lifestyle interventions are not that important, in my opinion’. ‘Yes, eventually the patient is responsible; however as a GP I can provide patients with information’. ‘The plans for behaviour change are made between patient and PN (…). Our role is just to support and consolidate this. Even if they come with a cold, I say ‘You want to lose some weight. Well done!’ ‘You want to create an atmosphere in which you radiate that and eventually it works somehow. Even if it is for later generations’. ‘If you see cigarettes in the patients’ breast pocket, do you have to say something about it or not? (.) If I am well acquainted with the patient, I do’. ‘You have to raise your patients and teach them how to deal with health in their life’.
‘I can improve very little at the individual level’.
‘Patients are doing a lot of simple primitive things wrong (…) I may discuss that with my patients’.
‘I think I am a health adviser’.
‘You must go on. On the one hand because there are (minimal) results and on the other hand because it is professional motivation. It is like ‘Médecins Sans Frontières’ an (international humanitarian organization); they go to a warzone, yes… and later on there is a new front. Shouldn’t they have gone out and help over there? You have to do something. You will help at least some individuals’.
‘I put all of them (fat ladies, WG.) on a weighing scale and I say: What do you think of it? (…) It’s a wakeup call. They don’t like it, but it has to be done, right?’
I think it makes sense to tackle bad lifestyle habits in order to prevent. And that we can say: well if you are not stupid, you have to get smart’.
‘I would never discuss the importance of exercise etcetera if there is no policy on a national or regional level’. ‘Advisory, not mandatory. I give advice and patients can do with it what they want. It is their responsibility’.
We try to motivate patients, using the power of repetition and the fact we are a team’.
‘Sometimes I lay my hand on one of those pot bellies and say: When is the baby coming?’
  ‘I will change my working method if the insurance company offers me a reimbursement’.