As humans, we fear change. So, what happens when our doctor recommends it? As it turns out, people are resistant to the idea even when the alternative is debilitation or death. For patients with problems such as diabetes and heart disease, a change in lifestyle could be life saving – but studies have shown that barely 19% of them manage it successfully.
When habits and practices are obvious factors in a health problem, a doctor really needs to step in, but the attitude of the doctor can make a huge difference when it comes to patient cooperation. I remember when my friend Joyce had a stroke – her first doctor was so judgmental about her weight and dietary choices, and so aggressive in his suggestions, that she literally ran out of his office. He upset her so much that I’m pretty sure she kept piling on the red meat just to spite him. But I also know some doctors who are hesitant to even mention lifestyle change, because they know people are likely to flip physicians if they can’t just get a pill. I asked my friend Dr. H. how he deals with patients who are their own worst enemy.
“This is really a difficult subject, but as a doctor I am confronted with it all the time and think about it a lot. Sure, it seems so obvious that someone who has had three heart attacks, or someone who can’t breathe anymore because they have emphysema, should quit smoking, and I ask myself, why don’t they see what’s going on? But over time, I came to realize – more often than not they DO see what’s going on; they just continue to smoke anyway. This same thing happens with problem drinkers and with patients who struggle with weight.
“I think people’s inability to change is due to a combination of many factors, and that the balance of those factors differs from person to person. As a physician, my job is to try to figure out exactly where to concentrate. I have to say that doctors are not always successful in getting people to modify their activities. It’s tough – sometimes we have patients with anger and other behavioral issues who are very resistant to suggestions. This is taxing on doctors in more ways than one – we are actually graded now by insurance companies on our success in these areas.
“Certainly to some extent there’s biochemical elements along with innate wiring in our brains that we don’t have control over. A perfect example is the whole issue of libido in men, which is very much controlled by testosterone. And there are some people who just need Prozac and their depression goes away without any talk therapy at all. Alcoholism does tend to run in families, but I think it’s from a combination of factors. The behavior that these people learn growing up has a strong influence … but they could also drink a six pack of beer and barely get a buzz while the rest of us have two and three beers and go to sleep; that particular trait is genetic.
“The media has a lot of influence on people. The advertising for vaping cigarettes made the habit seem acceptable, even harmless. We see people on the news exhibiting poor behavior and getting away with it, and it seems like this is okay. The President of the United States is a good example here.
“The issue of change is frustrating from a physician’s standpoint. If we press too hard with patients, very often they get turned off. We have to try to sense exactly where the limit is of what we can say. If we annoy our patients too much they’ll leave and go somewhere else, so to some extent we’re almost helpless. But I feel it’s practically unethical not to say something, so this issue becomes difficult and complicated. What helps keep us going are the patients who do quit smoking and quit drinking and lose weight – when you see the benefits, it all seems worth it.
“I think that, as physicians, we’re in the best position to educate people and show them how their diabetes, their smoking, and their weight is affecting their health. In terms of getting people to change self-injuring behaviors, education is probably our best option. There are many insights doctors can give people, but before we can even begin to try to change things, we need to understand why they eat or smoke or drink to excess. I always ask a lot of questions and do a lot of listening, and then and a lot of thinking and more questioning and more listening and over and over before I open my mouth.”
Change is hard, we all know that. But when lifestyle contributes to illness, it takes on new meaning – all the medicine and surgery in the world won’t do any good if we just keep making ourselves sick. Let your doctor help. That’s what you pay him/her for, and they would be delighted for a chance to up their grades with the insurance companies. Most importantly, remember this: When it comes to your health, the changes that you make can be as important as the care you receive.