Chronic diseases have a serious impact on individuals and on society in general. They affect the quality of life of individuals and can be a financial burden on those who are affected. There is a disease continuum of lifestyle, high risk diseases, and end organ damage. Lifestyle change is necessary if we are to reduce the prevalence of these chronic diseases. The Health Choices, Lifestyle Advice Resource for Healthcare Professionals provides a tool for lifestyle counselling.

Smoking cessation is a most cost-effective medical intervention and helping our patients stop smoking is a highly worthwhile endeavor. A doctor providing smoking cessation counseling will do well to first realise why many smokers are unwilling (or unable) to quit. This article focuses on why a doctor should emphasise smoking cessation in the prevention and management of chronic obstructive pulmonary disease.

Patients are often advised to adopt healthier behaviours or change unhealthy ones on the basis that what they are doing or not doing is detrimental to their health. Some of these changes may include going on a diet, exercising, stopping cigarette smoking and even relaxing and sleeping more. MI was initially developed by Rollnick and Miller as a strategy for addictive behaviour change, but it has found many applications in helping patients change other health related behaviours. MI was initially defined as a client-oriented, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The guiding stance, whilst respecting the patient's autonomy and the patient as the agency of change, maintain controls of the direction and structure of the consultation to evoke the patient's own arguments and strategies for change. The guiding process thus avoids the struggle or "fights" with the patient over changing behaviour and has been likened more to "dancing" with the patient. The four counselling principles in MI are: Develop discrepancy; Express empathy; Roll with resistance; and Support self-efficacy. Facilitating the patient to process and speak more about why and how to change then becomes one of the strategies to motivate change. In MI, this is known as change talk. Once change talk is elicited, the ways the practitioner can respond are: Elicit more (with open questions); Affirm; Reflect; and Summarise. Once the patient decides to change, goal setting becomes the next important process. Needless to say, the goal setting process must be done in collaboration with the patient, with the patient having the final say.

The ability to make informed health decisions is a complex process. Knowing when to consult a healthcare professional, understanding one's medical condition and learning how to take medicines correctly require that health information can be accessed, processed and applied effectively by the individual. These statements underpin the concept of "health literacy" which may be defined as the degree to which people have the ability to find, understand, act and communicate health information to make informed health decisions. To communicate at a level that helps patients to make use of health information, there is a need for the healthcare professional to first be able to identify and understand the patient's health literacy by considering age, gender, cultural background, education level, thoughts and behaviours associated with the topic under discussion, and perceived benefits and barriers towards the topic. Five strategies can then be applied for improving that patient's understanding and self management of his or her medical condition: (1) Assess patients' health literacy using open-ended questions; (2) Speak in plain language; (3) Limit the number of teaching points; (4) Use visual aids, and (5) Incorporate the 'teach-back' method to ensure patient understanding.

Smoking cessation is used to illustrate the application of health literacy principles to meet patients' needs. There are three areas to focus on : developing a health literate patient ; presenting information in a way that is easy to understand and use ; and creating a health literate delivery system that provides ready access to and delivery of health information and health services. The Health Choices ‐ flip chart tool kit for healthcare professionals launched on 1 September 2012 ‐ illustrates the elements of a health literate tool for communicating smoking cessation.

The scope of health literacy demanded of the present day health services user is broad. Enhancing physician skills consists of improving on 6 things : Recognise and assist patients with low literacy to overcome their information handling problems ; Improve usability of health information ; Improve the usability of health services ; Build knowledge to improve health decision making ; Advocate for health literacy in your organisation ; and Learn more about health literacy.

The Certificate of Cause of Death (CCOD) is an important legal document. The statutory duty of completing the CCOD is imposed upon a licensed medical practitioner by the Registration of Births and Deaths Act. The family physician is often in the best position to certify the cause of death when the death occurs in the community. Medical practitioners are permitted to issue CCODs ONLY when the cause of death is known and natural and if the deceased is not in statutory care. Deaths that are reportable to the Coroner include deaths from unnatural causes, iatrogenic events, or if circumstances surrounding the death are unknown or suspicious. Proper certification of cause of death is essential to avoid problems with the authorities and added grief to the family of the deceased. However, with better understanding of the process of completing the CCOD, the family physician can more confidently perform this duty and render a final professional service to their patients.

Common chronic wounds encountered by Family Physicians in the home care setting include pressure ulcers, diabetic foot ulcers, venous ulcers and arterial ulcers. Wound care management starts with a comprehensive wound assessment to determine wound characteristics and identify risk factors for non-healing. This is followed by optimising the wound bed using TIME principles that emphasises judicious debridement, management of exudate, and resolution of bacterial imbalance. An appropriate wound dressing is then selected based on wound characteristics and dressing properties. Finally, it is important to remember that chronic wounds are part of a patient's multiple medical comorbidities, and interacts closely with the patient�s social circumstances and functional status.The underlying aetiology and patient risk factors need to be addressed to optimise wound healing

Dysphagia is a common problem among the elderly either as a result of age-related loss of musculature and function involved in the act of swallowing, and/or because of neurological, degenerative, respiratory and musculoskeletal diseases that cause decreased swallowing function. Assessment for dysphagia is important to prevent serious complications such as aspiration pneumonia. Referral to the speech-language therapist for comprehensive assessment paves the way for proper management. The management may include diet modification, compensatory swallowing techniques, swallowing exercises or use of feeding tubes and facilitative devices.

Home respiratory support for patients in the home care setting can range from simple oxygen supplementation, non-invasive ventilation, to home ventilation support via a tracheostomy. A home care doctor may not be able to know everything about ventilator support, but he should be familiar with the medical care of patients requiring one, and know who to refer to should patients require ventilator adjustments or troubleshooting. The management of such patients is challenging outside the hospital setting and usually requires a multidisciplinary team effort from the doctors, nurses, medical social worker, respiratory therapists, vendor of the ventilator and, most importantly, dedicated and well-trained caregivers. This article will cover two other important topics that Family Physicians should know when managing patients who require home respiratory support: home oxygen therapy and tracheostomy care.