Tag Archives: health

On Walking the Talk

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NaBloPoMo 2016, Letters to Patients, Day 4

To My Patients Who Wonder, “How Healthy Is Your Diet, Doc?”

I cannot tell a lie, it kinda sucks sometimes!  I’m not a foodie, really.  In fact, I have maybe the least discriminating palate of anyone I know—everything tastes good!  I particularly love sugar, starch, salt, and oil—especially in combination.

So when I talk to you about the picnic plate method of eating—half stems/stalks/leaves/fruit, a quarter high quality lean protein, and a quarter whole grain—believe me, I understand the challenge!  In fact, every time I counsel you, I review my own food log in my head, and I resolve to visit the raw salad bar more often.  When I give advice or make suggestions, it’s not that I necessarily know better than you, or that I think I’m better than you.  We’re all here doing our best every day.  It’s my job to look out for your health, which research tells us is only 20% related to what I do in the clinic or hospital, and 30% related to your own habits (incidentally, it’s 40% related to your environment).  So if I can help you make even the smallest change for the better, then I feel useful.

When I ask you about exercise, sleep, stress management, and relationships, I am also taking stock of my own habits in those realms.  To me, these are the central domains of health.  And nobody has a perfect balance all the time.  Maybe you’re great at exercise, but your diet is the pits.  Maybe you eat really well, but you stay up too late at night.  Everybody’s patterns are different, and they shift over time.  Sometimes I might share my own fluctuating experiences with you, if it feels relevant and helpful.  But our time together is about you, not me.

I want you to feel free to ask me how I manage my own health.  It’s important to me that I Walk the Talk.  I will answer honestly, if sheepishly.  I will share my struggles with you.  I risk judgment by you when I do this, and I accept that.  One of you actually said, “Shame on you,” to me one time.  Maybe you feel judged by me, also?  I think that is inevitable.  We all judge ourselves, and then subconsciously project our judgments onto others.  I’m working on self-compassion—ask me about that, too!

It’s about strategy and execution, trial and error, and repetition.  No matter what the behavior change, the more times we try, the more likely we will finally succeed.  So the next time you come in and we talk about health habits, think of it as comparing notes, rather than reporting progress or regress.  If you found something that works, please share!  I might just steal the idea for myself.

On Primary Care

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NaBloPoMo 2016, Letters to Pateints, Day 2

To Those Who Disdain Primary Care:

Maybe you don’t know what you’re missing.

“I don’t need a doctor, I never get sick.”  And yet, optimum health means so much more than the absence of illness.  I am called to steward your health as a whole person.  I value the chance to know you as such.  I seek to understand your temperament, your history, your past experiences, and how they influence your current perceptions and choices.  That is how I help you optimize your health—by reflecting your own patterns back to you, so you may determine how they serve you, and when they need updating.

So often our daily routines take the path of least resistance, like spring runoff tumbling inevitably downhill between the rocks and shrub roots of a mountainside.  Without attention and navigation, topsoil erodes and the landscape can get disorganized, unstable.  But with some intention and guidance, we can channel your energy and activities toward the mighty river of health.  There your strengths and motivation preserve the ecosystem that is your best you, for the long journey of life.

As a general internist, I have the privilege of getting the first call when something takes you down.  I get to hear the story first, to initiate the investigation.  If I know you already, I can apply history and context in the most personalized way.  Together we can examine and understand the mudslide triggers (there’s almost always at least one).  We can make an appropriate plan to slow the erosion, and then rebuild.  With each episode, our tools sharpen.  We become a team.

I relish the chance to help you dig deeper into your own capacities for self-care.  Each encounter is an opportunity to share and connect, in service of your long term health.  I want you to live not just to be an old man or woman, but a STRONG old man or woman.

But to do that, I need to know you starting now.  I need to connect with you early and often, in good times and bad.  It’s a relationship like any other.  I can’t help unless I see, hear, and understand.  There is no substitute for time and contact.  So think about it.  I’m here to help.

On Training

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NaBloPoMo 2016, Letters to Patients, Day 1

To The Patients Who Trained Me:

Thank you, from the bottom of my heart, and God bless you, every one.

To the elderly lady with heart failure, who donated your body to science so that I may learn anatomy:  You were the greatest gift.  Your heart was literally as big as your head, and at the time I just thought it was peculiar.  Now I understand the extraordinary adaptive capability of the human body, and I marvel at it every day.

To the inpatients who endured hours of repetitive interviewing and clumsy physical exams by us medical students, all in the name of teaching:  Your engagement in the midst of your own suffering testifies to the infinite potential generosity of humanity.  Your contribution to medical education cannot be overestimated.

To the kindhearted artist in my resident clinic, the first patient to page me for advice:  You showed me that I knew what I was doing, even in training.  You had classic of sinusitis, and I called in the appropriate prescription.  In a moment of sudden panic I wondered if I should have called my preceptor first.  No, I can do this, I realized.  I’m meant to do this.

To the articulate, confident housewife whose retired husband drove you to me in acute agitation:  I learned from you that life phases never cease to evolve.  Our relationships, however longstanding, hold infinite complexities that manifest in jarring and also predictable ways throughout life.  You taught me that stability is overrated, and also underappreciated.

To the wonderfully kind man, one of my first patients in practice, who came in with the nasal balloon:  Your patience and trust will humble me forever.  The emergency room doctor had placed the balloon for a prolonged nosebleed.  He instructed you have me take it out.  I had never seen such a device before, much less deflated and removed one.  You let me examine it, think it through, and finally just cut the tubing with scissors.  We bonded over that and you continued to teach me about collaboration and sharing between patient and physician all the while I knew you.

To all whom I encountered in those early years:  There are too many of you to name, too many to acknowledge fully.  But every one of you helped make me the physician I am today.  With each new meeting now, each applied principle and physical exam technique, I thank you and honor you, my esteemed teachers.