Recently I ran a tutorial for some 5^th year medical students on health promotion.

In typical cheesy fashion, I started the session by getting the students to each complete the line, “Health promotion is ……..” We went around the circle and I received a number of encouraging yet predictable responses, such as “important”, “under recognised”, “interesting” and “time consuming”. However, the student that really caught my attention was the one who boldly declared that health promotion was “something that is best done in primary care”.

While I took issue with what he said, I could also completely understand this view. Not because it is true, but because somehow this is how we are trained to see things. The guy was at least honest, if (in my view at least) quite naïve.

Primary care almost automatically ends up with the responsibility for the more preventative side of things (‘the before’), while in the hospital we tend to deal more with treatment (‘the after’). Clearly this is a gross generalisation, and also plain wrong, but it is also how many – healthcare professionals and the general public alike – actually do perceive the roles of the different levels of care.

While we would all agree that health promotion is vitally important, the pressures of the job so often mean that we just deal with the acute issue immediately at hand, and can often neglect the opportunities to intervene and pre-empt other health-related issues. Many of us will relate to the common tactic of requesting (GP) follow-up on prevention-related issues. Yes, of course it is practical (translation: easier for us at the time), but does that make it right? It is not untrue to say that we sometimes don’t see it as our responsibility, but aren’t we doctors too? Why is it that we seem to think that GPs have a bigger role in this area? Is it time for us to step up more in this area?

Anyway, this tutorial got me thinking about the ways that hospital clinicians can promote health in our everyday work and what can be done to ensure that all doctors, no matter where they work, can approach this issue in a coordinated, consistent and appropriately prioritised fashion.

If, for no other reason, we should take health promotion seriously as it helps to reduce our workload! Why not at least try to make our working life a tad easier? Many clinicians express concern that working in the hospital environment can – at times – feel as though you are fulfilling the role of the ‘ambulance at the bottom of the cliff’. What we fail to recognise though, it that – even working in the acute setting – we have the real opportunity to address issues and concerns before people tip themselves over the proverbial edge. And of course we do this already. Can you imagine seeing a 2-packs per day COPD patient and not even mentioning their smoking while they are under your care? Generally speaking, of course we would raise the issue at some point and, of course, this is a form of health promotion. It is important that we see it as such so that we both recognise and actively continue the role that this has in our everyday practice.

So, what can we realistically do? Well, of course we can recognise risky lifestyle and behavioural choices and invest time to educate patients about healthier options. We can also take our role as patient advocates seriously, and this means taking it outside the hospital setting. Pay attention to the news; pay attention to what is happening in health-related policy; pay attention to what is happening in your neighbourhood that affects health; and if you don’t like it, say something! And then do something. Advocate for health-promoting change (whether political, social, legal, environmental, economic, or otherwise) in your community, not just in your immediate workspace. We have a responsibility to do so. Our hospital experiences might make us cynical about our influence, but some people do still listen to doctors! We should make use of this fact.

Research is another oft-forgotten way that we can promote health in our everyday professional lives. We can think about potential research topics and consider which topics look at health promotion. Of course, research into treatment is unquestionably important, but we also need to see that there are other options!

Finally, no matter where we work, we can advocate for the promotion of health by displaying healthy behaviours in our own lives. We can role model healthy choices.

What do others think?