What a privilege to do what I do. Every day I get to meet new people, learn new things, apply my own well-developed knowledge and expertise in fun and interesting new ways. My skills are continually sharpened by each novel interaction, and both confidence and humility are strengthened as well.
Before each full day physical, I ask patients about their highest goals for the day. Their answers can usually be paraphrased thusly:
“I’m looking for a comprehensive assessment of my current state of health, including risks. Let’s identify where habits are healthy, so I can protect/strengthen them. Then discover areas of vulnerability and potential improvement, and co-create a relevant, actionable plan to optimize patterns in the five reciprocal domains of health (Sleep, Exercise, Nutrition, Stress management, and Relationships).”
People get excited (maybe that’s too strong–intrigued, perhaps) to understand the complex interrelationships among patterns and fluctuations within and between the domains, both conscious and unconscious, including extrinsic/environmental/circumstancial factors and their insidious influences. They often start the encounter focused on the biometrics: cholesterol, body fat, etc. And if I do my job well, they leave also attending to the salient behaviors and all of their adjuvant drivers. My reward is when someone leaves the day feeling they were seen and known as a whole person, in their current context. Even better if I can also help them see and know themselves this way more easily.
I recently read Kate Murphy’s You’re Not Listening, which helps me do my job that much better. I was gratified to see that I was familiar and facile with many of the concepts and skills she discusses in the book. It’s not just about making eye contact, repeating people’s words back to them, and voicing sounds that may indicate listening, like ‘uh-huh,’, ‘right.’ It’s about being truly present, listening as a way of being before doing, putting aside our own prejudices, assumptions, judgments, and expectations as much as possible, attuning to the person in front of us–true listening is a practice in deep presence. Easier said than done! And always worth the effort for deeper connection. This connection makes the medical encounter a profound win-win.
Don’t all people deserve this kind of physician-patient relationship? Isn’t the primary care doctor’s job to inform, educate, explore, and conference with people, to help them enact their own health intentions ever more easily and confidently? As your doctor, I wish to help you recruit all the support you need for healthy decision making, to moderate overt and heavy effort–make the healthy path the path of least resistance. It takes a village! Humanities researchers have known for generations now that our behaviors and decisions are heavily dependent on our circumstances, environmental cues, and real time mental state (the more fatigued and stressed [and who is not severely fatigued and stressed right now??], the exponentially harder it is to resist the most immediately gratifying, comforting, and self-soothing behaviors). So it all just makes me wonder, at times with severe agitation: Why do we, as a society, make it so hard for us all to live healthily? Why do we make healthy food, childcare, and mental healthcare so inaccessible and expensive? Why do we make people work 3/5 of their waking hours at jobs that confine them to chairs and screens? Why do we shame and punish people for taking time for medical appointments and care? Why do we blame individuals, telling them both explicitly and implicitly how they are not aware enough, not doing enough, not good enough, when everybody is just doing their best in chaotic, inefficient, and inhumane systems of everything? ACK.
My corporate executive patient population is microscopic compared to the general population, and privileged to the extreme. Current state in American healthcare means that only the uber wealthy, highest status workers can access the care that I so luxuriously provide. I say every day how I have the sweetest gig in all of primary care. I understand and appreciate this deeply, and wonder honestly about its sustainability.
I wish for my patients to leave every annual physical feeling empowered to exercise your agency where the energy will be most efficient and effective, so that by one year from now you can come back and report how much healthier you feel, and why, owning your own actions and appreciating the help you got along the way. And if you’re not feeling healthier, we can talk it through, trouble shoot, and make a new plan. To this end, we doctors need the time, space, and resources to really know you, our patients, to understand the barriers to and facilitators of your best health habits and how it all intersects and evolves over time. Time is really the key here–there is no substitute for the time it takes to be fully present and to listen to the stories–to hear what is said and not said, attune to the subtle nonverbal cues, process it all and consider the best next open, honest, loving question. And then to hold temporal and personal space for thoughtful engagement. How and what we clinicians ask, and the energy we bring to each query, influence deeply (if not straight up determine) the answers we get, and thus the accuracy of our understanding, and the effectiveness and impact of our whole plan of care. Maybe I understood this early on, and that’s why I used to run 45 minutes late in a regular primary care clinic.
So how can we rebalance? As medical knowledge expands exponentially in volume and complexity, and our systems widen and dehumanize the distance between patients and their doctors (even more than when I wrote my ‘About’ page on this blog 8 years ago), how can we restore the close, personal, and healing energetic exhcange between us all?
I have no answers! Alas, our deeply broken and counterproductive healthcare system may be the quintessential complex-adaptive challenge. It requires leaders who can hold tension without anxiety, paradox and polarity without animosity, and patience and courage for experimental, iterative change.
Meanwhile, we workers and consumers of the system must find ways to connect and hold ourselves up, to get through the morass together. What I wish is that we all give ourselves and one another, including the folks who ‘run’ our broken systems, a little grace. I truly believe we are all doing our best. AND we can do better. Maybe it starts by simply listening a little better.
Healing Through Connection 