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’t“s 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.
Maybe sarcasm can be motivating….