Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, August 17, 2007

The "Oh Yeah!" Moment

From the comments:
I never actually looked at it from this angle before.
I never thought of positive thinking in this light before.
It's interesting how often something like this happens. A patient, family member, student, or even a random stranger on the internet points out something that, in retrospect, seems obvious. Things we say are not so much "misinterpreted" as they are interpreted in a manner consistent with our words, yet in total opposition to our intent. It all comes down to truly "walking in another's shoes," understanding how a patient can hear something very different from what we thought we were saying.

This whole thing is a merely a starting point for the realization that just about anything we support can be viewed as failure to support the opposite. For example, I favor breastfeeding. But once someone has made the decision to wean or bottle feed, they need (and deserve) respect and support too. Being overly enthusiastic about nursing runs the risk of insulting the mother who has chosen to bottle feed, or stigmatizing the mother who has been unsuccessful.

Exactly the same dynamic applies to natural childbirth. As wonderful an experience as it can be, those who do not choose it should not be vilified. Likewise, those who feel strongly that birth should be more than a medical procedure should not be ridiculed. Far too many people fail to see that their support for their way of doing things (the "right" way, in their view) can be insulting and demeaning to those who feel differently.

My original epiphany about this flip side of "thinking positive" occurred in the context of counseling a breast cancer patient once many years ago, though I've had similar experiences over the years. The most recent was just a few weeks ago.

I had a fantastic encounter* with a diabetic patient who took all his meds (including insulin) exactly as prescribed, but did nothing about his diet -- and had an A1C well over 10. Ate whatever he wanted; snacked like crazy on potato chips, pretzels; anything he wanted. I had diagnosed his wife with diabetes as well, and she, frankly, was feeling sabotaged and undermined by him as he encouraged her to join him in his unhealthy habits. When I saw him for a checkup, I set the chart down, leaned forward and got into a real heart-to-heart about why he was in my office. If he really didn't care if he lived or died (his response to my previous admonitions that he was going to wind up on dialysis, or have a stroke or heart attack if he didn't start taking better care of himself) then why bother coming back? To get his meds. But why even bother taking them if he really didn't care? Of course it quickly came out that he did care, wanted to live forever, and so on. From there, I suggested a very simple intervention with which he readily agreed, much to my surprise. We parted, both feeling pretty darn good about the visit.

When I saw his wife the following week, she told me, "You really made an impression on him. But you scared him to death."


"He thought you were going to dismiss him from your practice."

The thought had never crossed my mind! I was thinking more about why he was wasting HIS time coming to me if he wasn't going to take any of my advice. But upon reflection, it was obvious how he might think that's where I was going with the conversation. Another "Oh yeah!" moment, but one that taught me to be more explicit the next time I begin a talk along these lines. ("I'm not talking about dismissing you as a patient or anything, but I wonder why you're wasting your time coming here if you're not going to take any of my advice.")

Educators talk about "teachable moments." I guess those moments never stop happening. It just becomes our own responsibility to notice -- and learn from them.

*What made the rest of the encounter so rewarding was what came later. I suggested that he snack on nuts instead of all the high-carb foods he was consuming. Nothing about portion control; just the snacking issue. My strategy was "baby steps." Later, his wife told me he had come to her with some "menu suggestions" for the two of them. Somehow I'd managed to motivate him to move well beyond my modest suggestions. Totally made my day!


At Sat Aug 18, 06:19:00 PM, Blogger BillyBob said...

I appreciate what you are saying, and can relate to both posts. Though mentally I feel fine, Physically I just hurt, bad. Sarah was right. No one knows what lies ahead with my liver. No matter what positive things I focus on, the pain comes and drowns out all those thoughts... And I stopped drinking, smoking, I eat vegetables, lost 100 lbs, avoid diet pop and unnecessary chemicals, live on a strict low sodium diet. I want to live. We'll see...

At Sun Aug 19, 05:52:00 PM, Blogger Bardiac said...

Really great post.

Those "oh yeah" moments can be painful, too. Realizing you've done or said something a ton of times without having considered X or Y.

It's really hard to rethink attitudes or ideas we've had for a long time, too. Your example's really good because it's about you rethinking, rather than about making someone else rethink. It's way easier to point out someone else's moment than to have one's own.


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