An elderly gentleman presents to his physician for worsening hearing loss. After a thorough physical examination and a comprehensive series of lab tests, he returns to discuss the results. The doctor methodically reviews the findings and prescribes a low fat diet and an exercise program as well as abstinence from smoking and alcohol.
The reticent gentleman sheepishly looks up at his rather serious physician and asks, "Do you really think I'm about to do all that just so I can hear a little better?"
One of the oldest jokes ever told, this story needs to be revisited in contemporary medicine. For despite the myriad of treatment advances over the past few decades, now, more than ever before, people are faced with the prospect of substantial lifestyle changes in order to preserve or restore the gift of a healthy life.
And frankly, while change is never easy, compliance is even more challenging.
According to Merriam Webster, "compliance" refers to "conformity in fulfilling official requirements." "Official" refers to the source, which in this case is your doctor. "Conformity" suggests "to be in agreement with," and that’s where the real chasm develops.
For good medicine cannot be practiced with an emphasis on conformity utilizing a "one size fits all" approach. Without addressing the individual needs of the patient in the context of psycho-social-spiritual issues, education and socio-economic status, lifestyle modification attempts are bound to fail.
To complicate matters further, I'm convinced it's impossible to motivate any person to adopt a healthy lifestyle change without considering the framework of family, friends and even co-workers. Consider the following example:
John is a 52 year-old fictitious character recently hospitalized with a heart attack and a subsequent bypass procedure. A lifelong smoker with a strong family history of cardiac disease (his father died at age 53), he is 48 pounds overweight and a "couch potato" who thrives on junk food. His blood pressure has always been elevated and his cholesterol is well within the danger zone. Rarely does he see a physician. One doesn’t need a medical degree to understand his situation or to provide healthy advice.
While you might be saying to yourself he's not going to outlive his father, John is not a lost cause. Despite multiple obvious risk factors, he sees his heart attack as a wake-up call. For the first time in his life, he's considering a low fat diet, an exercise program and regular check-ups with his physician. Change has never been easy for John, but for now … at least he’s willing to try. Actually John is scared! And fear can sometimes be beneficial.
Yet our character is up against more than just the prospect of radical self-improvement. His wife and teenage children are chain smokers. No one in the family weighs in near the normal range. Meals are incomplete without voluminous seconds and thousand calorie desserts. Family exercise is competing for the remote. Relaxation is Poker on Tuesday evenings in a smoke-filled den where potato chips, dip and beer are the staple refreshments.
You’re right. How can one be expected to implement and sustain substantial lifestyle changes in such an environment? As health professionals, are we kidding ourselves?
Unfortunately, in many cases, we are. That 8-minute follow-up visit doesn’t even amount to plugging the dam with one’s thumb. The odds are that John will not outlive his father unless he makes some radical changes. A simple prescription is not going to fix the problem.
The question is, "How can we inform, educate and motivate John and his family to make healthy lifestyle choices?"
The answer lies in establishing "whole person" or better yet "whole family" comprehensive lifestyle change programs that specifically match the needs of our patients. The process involves support people as healthy lifestyle changes cannot be accomplished systematically without addressing the framework of the patient’s family and environment. Smoking cessation, proper nutrition and exercise must become established family practices.
What are the real chances of such change? Let's not kid ourselves, they're limited at best, I suppose. Yet there is one real reward in sight - it's saving the life of a husband and a father who has been given a second chance. Down the line, it may also be improving quality of life for children and grandchildren to come.
Our Heart to Heart program supported by a Department of Health research grant has many success stories already. It provides a host of meaningful options for patients and their families. Heart to Heart guides the way for those who wish to take an active role in preserving or reestablishing health and well-being. Through appropriate nutritional counseling and effective stress reduction and exercise programs, people can discover how to improve their odds. Is it worth your investment of time and energy? You be the judge - Mind Over Matter!
©2001 Barry Bittman,
MD all rights reserved