A Little More Thought On A Somewhat Controversial Post

motivational-interviewing-what-it-is-and-why-you-should-be-using-it-11-638In my last post, Doctor, Judge Thyself, I described how I go to great efforts to help patients make healthy lifestyle changes, and I admitted that I get frustrated and judgmental when met with great resistance.

The post generated significant page views and commentary, which signals to me that it’s worth continuing this conversation!

In all honesty, most of my patient encounters are positive. As long as someone is engaged and maintains even a modicum of a good attitude, I am thrilled. If they want to work with me, I love to work with them.

Even when a patient declares that they don’t want to change a thing, like “I’d rather smoke ’til I’m dead”,  I can walk away without a fight and without stressing about it. I have several patients with whom this type of flat-out refusal is a running joke:

“I know what you’re going to say, doc, and you know what I’m going to say, so why don’t we talk about baseball instead?”

I can laugh and retort with: “Okay, humor me with my little shpiel so I can write that I told you so in the chart.”

It’s only when I am met with the baffling “I want to change, doc, but I just can’t…” that I bang my head against the exam table, and that is what the post was about. It’s the help-seeking-then-rejecting thing. Drives me nuts. I don’t handle those situations well.

One physician, I believe an internist (Jay, please correct me if I am wrong) brought up the motivational interviewing technique, which is very good, and I do use this, though probably not enough, and not very well with the “I can’t”. Dr. Mom (Family practitioner) shared a method I hadn’t heard of that sounds particularly sanity-saving: “Goalification”. The technique is described in a very short, highly enjoyable article by Greg Dubord, MD in Canadian Family Physician:


It’s totally worth taking a few minutes to peruse this, if solely for the entertainment value of the sample encounter. I could see trying this in practice.

Eve Shvidler, an OB/GYN at https://burningtheshortwhitecoat.wordpress.com, commented about the techniques she uses, such as obtaining more details about diet and exercise. I think this is a very good idea, though I often feel like I need more education in nutrition counseling… and more time. At the very least, I need to find better resources for patients.

In the end, there is much food for thought here. I’m always open to hear more… There’s so much pressure on physicians, especially those of us in primary care, to push the masses towards better health. What else can we do… or not do?

Leave a comment

Filed under fitness

Doctor, Judge Thyself

I feel that the best doctors are the ones who are truly nonjudgmental. They can meet a patient where they are, and gently but firmly guide them along, whether with little tiny baby steps, forward two and back one, or big sweeping steps, onwards towards a healthier place.

I am not one of those doctors.

I’ve made patients cry. Not because I delivered any bad diagnosis, but because of my “you can make positive change” approach. I would like to say these are my overly enthusiastic attempts to empower my patients, but I don’t think that’s all true.

The truth is, I often feel frustrated, fed up, and, frankly, judgmental of the people who come in saying “I can’t do it.” And, I hate this about myself. 

I can’t” drives me CRAZY. I want to jump up and down and scream at the top of my lungs “YOU CAN, so get over it and let’s START TRYING!”

I want people to be motivated by the cardiovascular risk statistics I emphasize to them. I want to see people who are ready to roll up their sleeves and get working on the project.  I want people to take my nutrition advice. I want people to get up and move.

I can’t lose weight no matter what I do.” 

I don’t have time to exercise.

I can’t quit smoking, I’ve already tried.” 

These types of statements make my own heart rate and blood pressure rise. I feel myself getting worked up, ready to make my stand, and essentially, spend alot of their visit time on this one issue. This is a huge commitment when you’re a primary care doc with twenty minutes to cover this AND the Gyn-y stuff AND the psych stuff AND the health monitoring stuff.

But by and large, I do it. I don’t wade in, I jump. I say:

“Okay. Tell me why you think you can’t do this. Let’s go over what you’ve tried. I may be able to help.”

Which really means:

“Let me flush out all your excuses, and then, I will shoot them down one by one.”

Some people, realizing that all of their perceived obstacles have been effectively annhilated, will actually feel empowered to move forwards. But some will just emotionally collapse, I think because they are not ready to make changes. Changes are scary… and excuses are like security blankets. And it’s kind of cruel to yank someone’s security blanket when they’re not ready.

How have I become so evangelical about effecting healthy change? Over these six years as an attending, I have seen a few of my patients make real, lasting, positive changes.

A few of those few have cited my excuse-squashing-go-go-rah-rah-you-can-do-it  approach as instrumental to their success. 

This would be, very few patients.  

But, those successes are intoxicating. I can help people to get healthy! This is what I went into medicine to do!

But, also…. Doing a little self-analysis, I suspect that I get all up in arms over these “I can’ts because I have been there. I have struggled with weight: Hey, I lost fifty pounds of post-baby weight. I struggle with prioritizing exercise: Hey, I work, and I have two kids. I have quit smoking: Hey, I smoked for many years.

What I have to realize, or better yet, to process and absorb, is that we’re all different. I lost alot of weight gained during my pregnancies, but my pre-pregnancy weight was healthy. I work out, but I have alot of support from my husband and family. I quit smoking, but I never smoked more than a few cigarettes at night. So, the things I have learned from my own experiences aren’t always going to apply to someone else’s.

I’m sure other providers have had the same issues controlling their frustration or judgment as they try to help their patients.

Don’t they?


Maybe sarcasm can be motivating….


Filed under fitness

365 Days Of Potty Training

It was July 29, 2014 that I wrote about our first weekend attempt to get Babyboy out of diapers.  We used an excellent book on toilet training for autistic children called Ready, Set, Potty by Brenda Batts that was quite helpful. Babyboy did very well, and used the potty or toilet pretty perfectly… for a few weeks.

Then, he got sick, a prolonged respiratory thing, and he regressed. Completely. We let it slide, because he was so sick for so long. But when he got well, he was defiantly anti-potty. We tried again and again, but gave up after countless messes. We would literally run out of underwear and clothes. It’s been  SO frustrating.

Babyboy is now five years old. He’ll be going to kindergarten! We HAVE to get him out of diapers.

What’s more, Babygirl is three and a half, and we know she can do this.

So, I took a vacation day last Friday, and we tried again. This time, Hubby, Nana and I decided we would train both kids at the same time, and we would NOT back down.

Hubby is somewhat of an artist, and he drew pictures similar to the ones below. We filled a bowl with small candy prizes, similar to past attempts.

But, one new tactic: If anyone had an accident, they had to go “bottomless” until they could use the potty successfully. This proved to be the clutch motivator for Babyboy. He HATED being nekked from the waist down, even in the privacy of home.

And, as Babygirl really grasped the concept rather quickly, he saw how much positive attention and praise she was getting, and we think that was also a motivator.

We had many, many accidents the first two days. We stuck close to home and we stuck to our guns. (SO glad we have the “super-sanitary” cycle on the washing machine… ) Sunday was better.

Monday, Hubby dropped them both at “summer camp”.  They’re doing four weeks of full days at Babygirl’s private preschool, which is familiar to Babyboy (and better yet, they are familiar with him). We’ve been talking this up for weeks, that they were going to camp, that most of the kids in their groups would be using the toilet (which is true), and they they needed to as well.

That Monday morning drop-off was tough. Babyboy flipped out. He wouldn’t let Hubby leave… But, a classmate of his from special ed was in his group, and one of Babygirl’s former teachers who he recognized was his group leader. They put Babygirl in his group, initially, as well. With all of these familiar faces, he calmed down.

The report at the end of the day? He ended up having a great time, and he had NO accidents, at school or at Nana’s after school. No messes, until he got home… Big mess. Oh well.

Today went similarly well, with only one accident; Babyboy, at home again.

Babygirl has got the hang of it. She’s in love with her Disney Princess underwear. Babyboy has almost got it. He’s developing a pride in this new skill that everyone’s so excited about. Both of them have. They’ve been announcing to family, friends and neighbors:  “I did poopie and peepee on the potty today!” They’re relishing the praise and the high-fives.

We hope it lasts this time. But, we don’t have any daytime diapers left, so, unless we break down and buy another box, we’re done with diapers… Done with diapers… It’s like, a dreamy mantra. Done with diapers…after 365 days…   potty-training-autism

1 Comment

Filed under Uncategorized

Challenging Cases And Self-Doubt

It’s only Tuesday, and I’ve already seen several challenging cases this week. So much so, that I can’t sleep. I keep reviewing salient details and email communications in my head, worrying over what I may have missed, or how I may have come across. Did I screw up? Is this patient going to be okay? Does the specialist think I’m a dumbass? 

I’m far, far more secure in my clinical skills now than I was five years ago, but these nights still happen, when I give up on sleep and wander down to the kitchen for glass of warm milk with honey. Writing always helps to calm my spastically distracted thought process.

I know that this professional insecurity is commonplace, and that I am not alone. Somewhere right now, there are other clinicians fretting: the radiologist mentally reviews images that maybe do represent cancer; the psychiatrist rewinds the conversation that maybe will lead to an emotional unraveling; the surgeon flashes back to the operation that maybe will not solve the problem.

I’m tempted, now, to log into the electronic records and delve again into the clinical details, but I know that’s not healthy. Not at 1 a.m. when I’m exhausted. Better to sleep on it, and revisit things with the freshness of morning and a rested mind.

And so, feeling better, I sign off.


Filed under Uncategorized

The Garden Project: Priceless

Our almost accidental 4′ by 8′ foot backyard garden is now an almost endless source of everything: education, entertainment, nutrition…  The kids are still so excited about it! They poke around in there every day to see what’s growing, and this week, they were thrilled to discover a huge zucchini growing amongst what I had thought were ornamental gourds (I obviously got the labels mixed up). We’ve had handfuls of peas and green beans for weeks, and now the beets, colorful carrots, and chili peppers are coming in. I planted the tomatoes all too close together, and it’s a tangled jungle, stems heavy with clusters of baby cherry and heirloom tomatoes.

Babygirl has finally tried the peas, and with prodding, she’ll eat one or two. It’s Babyboy who really goes to town with the bounty. He still shells the peas and chops the green beans, but now instead of letting him make any imaginative (read: really gross) concoction, we only let him make edible arrangements. Like, a sauté with olive oil, sea salt, lemon… Last night he insisted on another ingredient, so I let him add a splash of white wine. Hubby and I then sprinkled the “gourmet soup” over our grilled romaine, roasted  zucchini and carrot salad.

We do have critters. They ate all our baby sunflowers right off the bat, and I almost went Caddyshack on them: I went online and ordered a scary plastic owl, reflective tape, wire fencing and stakes. But, other than put up the owl (another endless source of entertainment) I haven’t had any time to figure the rest out. While the tape, fence and stakes have sat in the box, a chipmunk has burrowed under one of the rows of peas. I pointed it out to the kids, and though they roundly scolded the little interloper, they also enjoy watching him skitter between the bird feeders and the garden. Babyboy talks to him. I figure, we have enough peas.

The Garden Project: 

Mail order cedar wood raised garden kit: $130.00

Fifteen bags of dirt and four bags of compost: $100.00

A gazillion seed packets: $50.00

Four seedling starter kits: $40.00

Bamboo stakes and fans: like $20.00 maybe

Scary plastic owl: embarrassingly, $15.00

Fencing and supplies: I lost track…

The enjoyment for our whole family…


IMG_4410 IMG_4407


Filed under Uncategorized

Vacation… All I Ever Wanted?

Let’s face it, working parents. A “family vacation” is a bit of an oxymoron.  Multiple consecutive days on around-the-clock kid duty is wonderful, but not particularly restful.

I admit, by the last day of our seven days at the beach, I was kind of looking forward to being back at the office. Clinic is demanding, but it’s also a respite from what I consider the more difficult job.

I thank God every day for these little ones, of course. We’re lucky, we’re blessed, and we know it. But man, we’re exhausted. And we even had a night of free babysitting from Auntie!

Why is this? How could a week at this gorgeous Maine beach with our two blissed-out children be anything but zen?

Ugh. I recall one blisteringly sunny day on the sand. We’d been there all morning; a fun time was had by all. But, we ran out of snacks and juice boxes, and both kids were showing signs of impending meltdown. Namely, getting irritable and whiney and beating the crap out of each other more than usual.

We called the retreat and they piled into the red wagon to go back up to the house, a few blocks away. But it was too late- they got into a full-out sibling wrestling match.  A whole family just arriving to the beach gathered round to watch as our kids fought, probably not realizing that the harried parents shoving things into bags a few steps away belonged to these wild children.

Hubby was struggling with the umbrella, and he yelled over to me: There’s strangers attending to our kids! Can you get over there?

I marched over in the deep, hot sand, calling out, They’re okay, they’re fine, nothing to see here, folks! I was feeling rather irritable, myself. I grabbed the wagon handle and started the hike, as our lovely little ones alternately screamed and giggled, nearly tipping the wagon, the whole way home. I could almost hear the observers commenting on how little control we adults had over our preschoolers.

Ah, moments to remember. (And, I’m sure they’ll be best friends someday…)

Overall, our family trip was a great break. But, how nice it was to get back to work!

Busy on the beach when it's sunny...

Busy on the beach when it’s sunny…

…and when it's rainy

…and when it’s rainy

Leave a comment

Filed under Uncategorized

Sadness; even then there may be beauty. 


A wonderfully written memory by a former labor and delivery nurse… A little story that can only be described as beautifully sad.

Originally posted on Be Inspired:

You learn through experience, so it has been proven. The child that touched a hot stove, the injury to the flesh is his teacher. The child can see, feel and touch why he should in the future beware of hot stoves. Of course, there are some words spoken but this lesson is tangible and straightforward. The process by which we learn about emotion, well that can be a different experience all together.

The nursing profession is a wonderful venue for experiences that could, if one was receptive, teach the more difficult life lessons. I value the years I spent completely and solely dedicated to nursing. There are experiences that penetrated my being and have resided there since. Whether labeled “happy” or “sad”, each is equally as vital to my development. I recall this one in particular often.

I could not have been older than 26; I was an eager and…

View original 602 more words

Leave a comment

Filed under Uncategorized