Practical Advice for the “Healthy” Patient

For many of us in primary care, the typical patient is “healthy-ish.” She might be overweight but not morbidly obese. He might be diabetic but manages his disease with a single medication. She might have high cholesterol and hypertension but otherwise has a negative medical history.

Clearly, these patients could be healthier, and their minor medical problems now may very well escalate to life-threatening diseases in the next few years. When we see them in clinic for acute problems, we often address the acute problem. When we see them for a yearly physical, we diagnose the problem, adjust medications, and make a few comments about diet and exercise. But we can do better.

When I encounter patients who have resolved their diabetes through diet and exercise, or who have lost fifty pounds in middle age, or have quit smoking after fifty years, I ask them how they did it. These are some of their tactics:


A fifty-year-old man was diagnosed with type 2 diabetes just before his fortieth birthday. He had been sedentary, ate a lot of convenience foods, and lived alone. The diagnosis was the proverbial wake-up call. He decided to start walking three miles a day, rain or shine, 365 days a year. In the summer, he walks early in the morning or late in the evening. During the winter or on rainy days, he walks in the local mall. He has turned his walks into opportunities to catch up with friends. Sometimes he walks with a friend in-person. Other times, he plans a phone date for a specific time when he will be walking. Although his diet is still not great, and he has no intention of running a marathon – or even a 5K – any time soon, this man now has a normal HbA1C and no evidence of diabetes.


A fifty-five-year-old woman had been yo-yo dieting since her mid-teens. However, she has been a normal weight for five years now and feels like she can sustain this weight loss in the future. What worked for her? Weight Watchers. The sense of community and accountability has kept her on track. Although she does not cook and eats all of her meals in restaurants except for breakfast, this woman makes good food choices and has taken up exercise classes at her local YMCA. She says that the key to maintaining a good diet is to make sure that each of her meals include fruits/vegetables and protein.

Smoking Cessation

Oddly enough, more than a few long-time smokers have told me that they finally quit smoking after a hospitalization. For some of these patients, the hospitalization was due to a planned hip or knee replacement. For others, it was for a severe infection or some other acute event. While in the hospital, they were not allowed to smoke – and when they went home, they realized that they did not miss smoking as much as they thought they would. It seems that even for long-time smokers, health care providers should not miss the opportunity to instigate smoking cessation programs around the time of routine-altering events like hospitalizations.

Clearly, these case studies are all n = 1. However, it may be useful to keep these tips in mind for those times when patients want to know, “What can I do to be healthier?”

Dr. V. Silverstein
Durham, NC

Published on 2/5/18