My motivation for seeking proficiency in the healing arts has always been the amount of gratuitous suffering in the world. I don’t know if it was my Catholic upbringing or the ubiquity of that great existential bumper sticker in the early 90’s, but I was able to handle the fact that s#!% happens in life. I knew there were some hardships in life that were unpreventable or unavoidable. Poor health was not one of these things.
As far back as I can remember, I’ve been focused not on sickness, but on our human potential to perform at our optimal capacity. This definition of health has left me acutely sensitive to the amount of avoidable disease and dysfunction some of us are so willing to accept as we age. I’ve been told countless times that getting old isn’t easy and that I should expect immense deficits in performance in the years to come. Now, I know enough about the endocrine system to know that there are cycles in life that make us more resilient in our younger years, but to accept a second act full of aches, pains, indigestion, and incontinence? Is that really “normal” or just typical in our society? Is sickness or health our default setting? I think many of us have answered these questions for ourselves without even knowing it. It is time they come to the forefront of our consciousness in order to more effectively leverage the proliferating onslaught of public health and anti-obesity campaigns to come.
Lasting behavior modification must first start with personal introspection. In other words, the message has to mean something to the person before it can be trumpeted from the mountain tops.
Allow me to explore how my ideas of health were developed:
I never really got sick as child. I was told I had good genes. I also had a nurse for a mother so I grew up priding myself on my health. While my peers never left home without a jacket and remained skeptical of the 5-second rule, I threw caution to the wind when it came to doing things that might make me sick. I grew up just before the “Purellization” of America, but if the stuff had been around during my childhood, I’d like to think I’d be the only one in my class to proudly NOT have the travel bottle ever affixed to my backpack.
My view of sickness at this point in my development was that some people were “blessed” and others were not. We were just all at the mercy of our genes.
As I learned more about pathology both in the classroom and in real life, I began to realize that we have more control over our health beyond our genetics, socioeconomics, race, etc.
Even ignoring the emerging evidence in Epigenetics (the idea that we can turn certain genes on or off through our behaviors/environment), there is a great potential for controlling our outwardly expressed health through mindset.
Starting off with the idea that the human body is born broken and in constant need of healthcare intervention in order to function properly sets one up for failure. This ethos is firmly implanted in to the minds of some of our most difficult patients. It fosters a learned helplessness and low self-efficacy that is nearly impossible to overcome…unless we acknowledge it.
We in the healthcare community are dumfounded by some of the reactions we get from our “problem patients”. We simply can not understand how somebody can be so objectively ill and not be willing to do anything about it. What we fail to realize is that often times, a deep sense of security is at the heart of their unwillingness to change. Safety and security are major contributors to the inertia of our “problem patient’s” mindset.
But how can anybody feel safe and secure when they are being informed of their dangerously abnormal lab results?
We can share all the scary numbers and statistics in the world but if we fail to offer an equal amount of security to offset that provided by the sickness, readiness to change will remain low. For many chronically ill patients, they have found ways to deal with their diagnosis. Sometimes it is denial and other times it is full acceptance. Such acceptance demands that they find a way in which they can justify being sick. In other words, they find a use for their sickness. The only way to live with the harsh reality that you are somehow flawed or broken is to normalize your situation. Their sickness becomes their crutch.
The manner in which the sickness serves the individual is highly subjective. For some, being Diabetic allows them to snack more often. Perhaps having chronic migraines or GI upset means you can have a pre-made excuse to decline social invitations. These are a couple of examples of some of the more superficial “crutches” I’ve observed over the years. Sometimes the normalization is rooted deeper in the psyche. Incorporating a diagnosis in to ones sense of identity offers them an explanation for short-comings in other aspects of life. If they are not as successful as they think they should be, they can blame it on the disease. If they are unable to find a companion in life, the disease helps fill that void in that it is a way of relating to others dealing with similar circumstances.
The first step to furthering change is to explore the subjective manner in which the sickness is serving the patient. This isn’t an easy process and it may take some time. Sadly, time is not a commodity afforded to healthcare providers because it is not valued as a worthy intervention unto itself. My wish for the evolving model of care delivery is that we maintain venues for “change talk” to occur.
The award-winning documentary, Escape Fire, peels back the healthcare debate beyond who should and shouldn’t pay for their own health insurance. This bold film questions whether or not the system that we are currently offering is one where health is even the emphasis. We see fewer numbers of primary care physicians and more specialists. Productivity is becoming the magic word in healthcare. Physicians are evaluated not on the health of their patients but on the number of patients they see.
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- Primary Care is not without its Own Problems (rippblog.wordpress.com)
- Why Progress in Healthcare Requires a Healthy and Diverse Health IT Ecosystem (medcitynews.com)
- Putting Serious Games for Health in the Chronic Care Model (pamkato.com)