Earlier this week, John Sharp tweeted a link to a New York Times column by Abigail Zuger, MD, about the “Unworried Unwell” — people who have been told that they are very ill, but do not seem to want to do anything about it. The comments are wonderful, particularly the Reader’s Picks, including helpful tips about how to motivate behavior change or be more understanding of individual choices. Two stood out to me:
[In response to a comment arguing that people who welcome death’s release should not be criticized.] Yes, death can be a welcomed relief, however for many people, death typically doesn’t come as a thunderclap, suddenly and all at once. For the woman with the untreated hypertension, she is more likely to have recurrent problems, progressive kidney dysfunction, failing eyesight, repeated mini-strokes, other circulatory issues, in a chronic negative progression rather than suddenly dropping dead (although there are some whose exit takes that path). I have known many elders who are unafraid of death. That’s admirable. Given what I’ve seen in the office what more people should be afraid of is chronic debility and functional losses from un or undertreated chronic diseases. – GeriMD
Never, never abandon a patient. Plato: Be kind, for everyone you meet is fighting a harder battle. – Philip G. Miller, MD
How can we help someone to see that bigger picture? How can we help each other to never abandon someone in need? It’s not going to be yet another study, that’s for sure. (The Onion has it about right: New Study Finds Nothing That Will Actually Convince You To Change Your Lifestyle So Just Forget It.)
Abbe did a quick presentation about how IDEO approaches their projects, then gave us two case studies to ponder. She split us into two teams and gave us specific tasks – write down one personal health goal on post-its and group them on a board, for example. It was so participatory that I only took one note – that IDEO asks “HMW” questions to help prompt new thinking: “How Might We…” The final project for my team was to create a visualization of health that would motivate someone to change their behavior. We had a wonderful time brainstorming and then cutting, pasting, taping, and drawing our way to complete “The Goalposts of Life” – a representation of 3 lives, the grandfather’s cut short by a heart attack (with pictures of what he left unfinished), the father’s (with pictures of his new healthy lifestyle and longer life goals), and the son’s (all the dreams he has for the future).
Here’s a crazy idea: What if there were art supplies in waiting rooms and trained facilitators to help people visualize their life goals? Would that change the clinical conversation?
I was also reminded of the testimony of a patient advisor at the 2008 Chronic Disease Care conference sponsored by the California HealthCare Foundation. An excerpt:
Ardes Gardner, patient advisor: Played in the NFL for two years and learned to eat “heavy and hard.” “I ran from diabetes for 10 months. Providers: don’t stop repeating the information, never think your work is in vain. Thank you for constantly shoving that information in my face.” His 10-year-old son is his major motivation to get better and talking openly about his health is his new mission. “No one at my church had diabetes until I stood up. Then everyone came forward.”
During the Q&A, an audience member asked if a provider can create decision points like the ones which prompted Nancy and Ardes to make positive changes in their lives. Ardes answered, “No, if the patient isn’t ready, they won’t make a change.” He counseled providers to screen for depression and aggressively treat it, but stop the fear-mongering since “it becomes meaningless.” He said that providers can continue to remind patients about how to manage a chronic disease, but the why comes from within each person.
What do you think? What has motivated you to change your habits? Where does the why come from?