Goals

The art of medicine includes finding those aspects in our lives that motivate us for self improvement. Goals, whether physical, spiritual or social, are very important for long-term health and satisfaction in life.

A fascinating interaction occurred this past week when a patient told me her source of motivation to shed some pounds. She had gone with her granddaughter last summer to Cedar Point, a popular amusement park in the area. They had waited the typical two hours before a popular ride only to discover she was too big to fit inside the seat for the roller coaster. Due to her granddaughter's aversion to such rides without a loved one next to her, the two of them had to leave the line.

She resolved that she would lose the required weight. Since last summer she has now lost 40 pounds and plans to lose another 40 before she and her granddaughter venture out again. Not only is she more mindful about her diet and movement, her health has improved as well. She is no longer taking insulin for her diabetes. Her blood pressure is the best it has been in years. She is laser focused on the goal.

What is your seat in a roller coaster? How will you get there? Let us know!

Unique Skills

For a loving care relationship, I need to humble myself with my patients and appreciate their roles and contributions to their families, friends, and community. Inherent in this effort is for me to seek out those unique skills inherent in each person's life so I know more about who they are.

A patient who runs his own landscaping business told me the other day that he had been asked by one of his clients to install a mailbox. He had the same reaction physicians may have to a question we may think is common sense self-care issue (e.g. trial of OTC cough and cold medications for a mild upper respiratory infection); he wondered how "the man of the house" wouldn't know how to accomplish this relatively easy task. For additional background, the client is an anesthesiologist, the medical specialty involved in caring for patients during the pre-, peri and post-operative period. (For full disclosure, my own technical expertise isn't much different. In fact, I believe my wife changed out our mailbox the last time this home improvement item was needed!)

He went on to say that he and his team members have built a fair amount of trust with his various clients over the years. His daughter had even been asked, at one time, to help deep clean the same client's home in preparation for a holiday party. Following the job, she commented to my patient that this physician had a large number of books in his library and was obviously well-learned. His conclusion to me was highly informative and insightful:

"I don't have the toolset in my garage to put people to sleep. Why should I expect him to have the toolset in his garage to change out a mailbox?"

The medical applicability to this acknowledgement is that we may tease out additional information that is highly useful for the diagnostic work-up and treatment plan. We just have to be curious and tease out this additional information. More and more, work places expect the healthcare team to determine functional status and disability for work. Activities of daily working, if you will, can be just as important as your activities of daily living. In addition, we may learn, during our questioning, that certain tasks patients accomplish on the job or for their hobbies may be contributing to their underlying concerns as well.

We each have our various toolsets. We each have our skills. Find them and use them.

SECRET WORDS/PHRASES: "Job-related concern" "I think my problem may be related to my job / hobbies." For providers: "What do you know how to do that I probably can't do?"

Honor your Values

Values inform the overall principles of life we all follow. They are the basis of both upbringing and personal experience. Although I am a fierce advocate for certain measures and approaches that benefit the collective health of our communities, I am also a fierce defender of the freedoms you have from making decisions that are not consistent with your values. The irony is apparent in my own background as the son of a pastor and a teacher, professions that advocate for both personal faith and informed education. As a patient within the larger medical community, you serve as your own broker of honesty and forthrightness.

The issue of immunizations is probably the most common bone of contention for health professionals. A strong contingency exists within the medical community against anti-vaxxers, as they are called. These folks often have anecdotal stories they read on the internet (for which the patients rarely have a specific link or reference) but others have real experiences. One family I recently encountered had a grandmother who died of Stephens Johnson syndrome following an influenza vaccine. They predictably refuse the flu vaccine each year.

Other interactions have been from the less informed. A pregnant teenager advised me at one point she had done some research on the internet and didn't want her baby to be exposed to any unnecessary vaccines. This sort of naivete is both frustrating and challenging. As above, my advocacy stems from the Master of Public Health whereas my defense of freedom has its origins from my military service.

The ultimate charge to fellow professionals is to elicit patients' values and correlate them with the important moments and decisions in our practice. Critical decisions regarding end of life, the role of medications, initiation of lifestyle-related decisions such as dialysis or other life-changing issues require both open ears and a caring voice. Your unique self informs these values and we should honor them.

Do Nothing

A mentor and military leader once taught me the phrase, "Don't just do something; stand there." Too often we believe we are in an urgent situation when we actually have time to reflect. Particularly when there is a vetting process, we should pause or take a step back and survey the scene. We can apply this same approach to medical decision-making as well. Mindful consideration of the differential diagnosis is highly valuable, particularly when the underlying cause is not clear. In fact, the differential, as we call it for shorthand, is important to ponder even when we think the presentation is clear, preventing us from falling into the easier mindset that common things happen commonly. In addition, we should not fault (or perhaps even celebrate, applaud, or encourage) the brave souls who decide NOT to go forward with the next step in the evaluation or therapeutic process. An informed patient is sometimes the best partner to decide collectively to just stand there and be together.