A Prescription for Stress
When Vladimyr Lucien developed stress-induced minor health problems earlier this year, the 33-year-old’s doctor referred him to a “stress management” physician to help him handle the daily demands of life.
Always open to trying new things, whether it’s a new restaurant or activity, Lucien was very willing to take his doctor up on his suggestion and made an appointment with Dr. Aditi Nerurkar, a primary care physician at the Cheng and Tsui Center for Integrative Care at Beth Israel Deaconess Medical Center (BIDMC).
What Lucien discovered at his appointment with Dr. Nerurkar was that his stress levels were much higher than even he initially thought.
“I was surprised to see how stressed out I really was,” Lucien says. “Even though I may not have felt it so drastically, it just shows what work, family, friends, school, other obligations can do to your health.”
Research shows that 60 to 80 percent of patient visits to their primary care physician (PCP) have a stress-related component to them. However, data that was obtained from the National Ambulatory Medical Care Survey (NAMCS) by Dr. Nerurkar and her colleagues found that from 2006 to 2009, only three percent of office visits included stress management counseling by PCPs.
Last June, Dr. Nerurkar incorporated stress management into her practice after seeing the proof that stress counseling was largely absent from primary care practices.
“Almost half of Americans reported an increase in psychological stress over the past five years,” says Dr. Nerurkar (right). “Stress is the elephant in the room. Everyone knows it’s there, but physicians rarely talk about it to their patients.”
Dr. Nerurkar’s research, which was published last January in JAMA Internal Medicine, found that stress management counseling was the least common type of counseling provided by physicians.
Of the 5,105 physicians surveyed by the NAMCS, 17 percent provided nutrition counseling, 12 percent dispensed exercise advice, six percent talked to their patients about weight reduction, and nearly four percent brought up smoking cessation.
“Considering what we know about stress and disease, this clearly points to missed opportunities,” Dr. Nerurkar says.
In the 40-minute stress management assessment that Nerurkar performs, she first measures a patient’s stress level over the past month via a 10-question validated “perceived stress scale” test.
After discussing a patient’s stress triggers and teaching meditation and breathing techniques a patient can use to deal with them, Dr. Nerurkar writes a stress management prescription tailored to a patient’s lifestyle that includes exercise, relaxation strategies, sleep hygiene tips, and dietary advice. The stress counseling is covered by insurance.
During Lucien’s visit, he practiced breathing and meditation techniques with Dr. Nerurkar and she encouraged him to participate in activities that he enjoys.
“During our conversation, she figured out that tennis is a passion of mine,” Lucien says. “I haven’t played in a while but she emphasized that I should be doing it more because if I’m enjoying it, it will be healthy and relaxing for my body. I followed her advice and it has helped a lot.”
Nerurkar repeats the stress assessment on follow-up visits to help gauge whether patients are better coping with their stress after trying her prescribed techniques.
Lucien said his stress score drastically dropped over the past three months after he started playing tennis twice a week, meditating for five-minute sessions, and eating more fruits and vegetables.
“My colleagues at work noticed a big difference and told me I seemed more relaxed,” he says. “And they didn’t even know that I was going through this stress management counseling, so that really says a lot.”
HealthCare Associates, the primary care practice at BIDMC that the Cheng and Tsui Center for Integrative Care is a part of, may be one of the first practices locally to offer stress management counseling to the patients.
“As primary care physicians, we are responsible for keeping our patients well, and not just treating them when they get sick,” Dr. Nerurkar says. “With this in mind, the hope is that more practices will begin to incorporate mental health services within primary care.”
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted November 2013