The Boston Globe's Laura Kotz this week examined why some Boston-area physicians are helping patients manage stress with yoga, breathing exercises, and other non-pharmaceutical options.
Stress can hurt health—but few doctors address itResearch shows that 60% to 80% of medical complaints are exacerbated or triggered by stress. "A lot of chronic conditions that we see in primary care have a link to stress, like migraines, stomach complaints, depression, and insomnia," says Aditi Nerurkar, who runs a stress-management practice at Beth Israel Deaconess Medical Center. Stress is also "a known risk factor for heart disease and diabetes," she adds.
However, Nerurkar found that stress counseling was largely missing in most primary care practices.
In a study published in JAMA Internal Medicine this year, Nerurkar and colleagues found that only 3% of 5,100 family physicians participating in government surveys said they discuss stress management with their patients during office visits. Of those doctors, 17% of doctors provided nutrition counseling and 12% dispensed exercise advice.
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How doctors can help patients manage stress—without pillsAccording to Harvard's Russell Phillips, physicians may avoid offering stress management because they "don't feel prepared to teach stress-management techniques, and it raises the question as to whether it's something that a doctor does or perhaps that a health coach should do."
Phillips is currently working with 19 large primary care practices in Massachusetts to develop team-based approaches to mental health counseling and other services. Some of the practices involved in the initiative offer yoga, meditation, and tai chi classes as part of its stress management.
Getting insurance to pay for the stress-management class can be challenging—especially if a physician is not teaching the class, Phillips says.
Boston Medical Center (BMC) was able to get patients' stress management covered by insurance by creating physician-led courses in deep breathing, yoga, tai chi, and healthy cooking. "We're really interested in teaching these techniques to help patients reduce pain from chronic conditions like arthritis to reduce their reliance on prescription painkillers like narcotics," says Paula Gardiner, one of the BMC physicians teaching stress-management courses.
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In a study of 51 patients who completed eight weeks of BMC courses, Gardiner found that the patients experienced improved sleep, decreased depression, and decreased baseline pain scores. On a 10-point pain scale, patients decreased their score from 7.2 to 6.4 over the eight-week period.
Meanwhile, Nerurkar's "prescriptions" are covered by insurance. She first assesses a patient's "perceived stress scale" in an initial 40-minute assessment and writes prescriptions for stress management that include meditation, exercise, sleep, and diet, and offers courses in how to meditate. Nerurkar then continues to measure stress levels in follow-up visits.
Kotz writes that one of Nerurkar's patients' stress levels dropped from 25 to 13 in three months after he began meditating for five minutes per day, playing tennis twice a week, and eating more fruits and vegetables (Kotz, Boston Globe, 11/4).