The lifestyle (LSx) prescription: another use for the pad

Stroke survivor and smoker

A 59-year-old stroke survivor who had stopped smoking while on the inpatient stroke rehabilitation unit resumed the habit after returning home. Two months after discharge, HMF wrote a lifestyle prescription that stated “Stop smoking. It’s not good for you.” The patient was somewhat aphasic, but she seemed to understand the message, as did her husband. HMF told the patient to stick the LSx note on the refrigerator.

At a subsequent visit two months later, the patient said she had not smoked for the past six weeks. When HMF asked why, the patient stated in her halting aphasic way: “You … wrote it down.” Her husband explained that each time she went to get something from the fridge she would “read the note aloud and shake her head. … It bothered her.”

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Constipation

In this case, that of a 62-year-old woman, constipation was discussed. Ad nauseum. The patient stated that she was doing everything necessary, including ingesting appropriate fluids and fibre. However, the history indicated that she was not. The following lifestyle prescription was written:

• Eat only whole wheat bread. No white bread.

• Drink five to six glasses of water per day.

• Have a bowl of bran cereal every morning, seven days a week.

• Eat two to four fruits and two to four vegetables daily.

The patient followed this regimen, and her constipation ended. She informed HMF that she followed the note to the letter.

Interventions to improve patient recall of medical information have been systematically reviewed.2 Audiotapes, pre-consultation question prompt sheets and summary letters were noted to have minimal positive results. Print intervention was shown to “promote recall of health-related information.”3 The concept of the lifestyle prescription goes one step further by documenting a desirable course of action. The risk of paternalism is obviously hovering in the background, so the prescription must be delivered after much patient–physician dialogue and discussion.

Lifestyle prescriptions are spontaneous, specific and goal-directed. If you tell patients to “Take this note home and put it on your fridge” they often will comply. Why? Perhaps specific information, in a written form on a prescription pad, creates a more serious but at the same time caring atmosphere. Or perhaps the note simply allows the patient to remember what he or she has been told.

Obviously a lifestyle prescription is just one step in the whole process of medical practice. However, in our experience the results speak for themselves: improved compliance, reduced unhealthy lifestyle choices and greater realization of the role of psychological and social factors in illness and health.

Lifestyle prescriptions — LSx — try them.