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by Donald B. Ardell, Ph. D.
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Wellness in the Headlines
(Don's Report to the World)

A Dozen Suggestions For Making Personal Responsibility More Appealing To Patients (Part One)

Tuesday October 16, 2007

Introduction
On October 17, I have the high honor of addressing physicians in Des Moines at the annual meeting of the Iowa Academy of Family Practitioners. The timing is great because Iowa doctors, like everyone else in the state, are probably sick to death of hearing about politics from Republican and Democratic presidential hopefuls. My message about promoting personal responsibility is, in fact, about promoting wellness as part of doctoring. I hope my speech on the topic of wellness promotion options will be more interesting than the tiresome promises of Hillary, Barak, Rudy, John, Mitt, Mike, Sam, Joe, Fred, Dennis, Ron and so on. Unlike the politicians, I plan to steer clear of politics. I'm going to limit my talk to sex and religion! I expect everyone will be grateful for that.

OK, just kidding. I'm going to go easy on sex and religion, as well as politics. I'll offer a dozen suggestions for expanding the doctor role. Yes, I am aware that physicians are already overloaded with medical duties. However, I think the add-on wellness mission will enable Iowa doctors to help patients seize teachable moments. The latter are inherent in illness encounters. Physician efforts at wellness education might spark reforms in the attitudes, expectations and consequent behaviors of patients -- if the doctors add a few (or all) of my dozen suggestions to their regular agendas. The results, I believe, can lead to advances in quality of life, happiness, health status and all the positive outcomes we associate with wiser lifestyle choices.

Now all I have to do is convince the Iowa doctors that this is true. This essay summarizes what I plan to say.

An Aside
After I had identified and organized these suggestions, I got quite enthused if not carried away about this new doctor role I was about to unveil. In fact, I got so enthused I decided it might be really cool to become one, that is, a real doctor, as in MD. I'm thinking of applying to medical school. Given that I'm nearly 70, however, it is clear I don't have a lot of time to fool around with preliminaries. I can't spend days on applications, weeks on campus visits or months preparing for tests or taking perquisite courses to buff up thin background in chemistry, math, biology and other sciences. Instead, I might have to ask the Iowa Academy of Family Practitioners to waive all these and other preliminaries and requirements, plus tuition and other barriers to fast tracking of my new career. I'll let you know if this works out. 

Caveats
This presentation summary identifies the broad nature of my dozen suggestions. What follows, please remember, is but a humble essay, not the stand-up performance the good doctors will experience. All memorable, meaningful images that will be projected while I speak are absent here, as are references to the costumes I'll wear, the set design, the fireworks, the magic tricks and the varied dances, songs, wellness healings and doctor testimonials planned. Space limitations, you know.

I'll even mention a few caveats at the beginning, all designed to ensure reasonable expectations.

For example, I'll admit that while all dozen suggestions seem sensible, desirable, doable and consequential to me, I could be mistaken. Some may not appeal to everyone. Few of them can be implemented overnight. Templates do not exist -- the best ways to actually carry out my ideas will have to be determined in relation to local conditions, barriers, characters and opportunities. Finally, although the list of caveats could be longer, I'll mention the obvious fact that some tips might be a "piece of cake" to implement and afford quick payoffs, others will take time. A lot of time, in some cases.

Of course, the biggest caveat of all is to acknowledge that there would be no need for doctors to attempt to make personal responsibility more appealing to patients if everyone acted sensibly, that is, did not pursue lifestyles that have made America the fattest nation on earth with the most expensive medical system. But, that's how it is. People are not taking much responsibility to stay well in the first place, and while that might be good for your sickness care business, it has placed the nation in a fix where we are improvising on the edge of catastrophe.

That's it - no more caveats. It's good to cover your butt with sensible expectations but one must not go too far. I hope this won't overdo it.

And now, no more folderol. Here are the dozen suggestions I'll offer for doctors who might want to try making personal responsibility more appealing to patients, in addition, of course, to still providing quality medical care efficiently and effectively.

The Suggestions

1. Dazzle patients - and get to the heart of their problems. You can do this in the first 30 seconds of initial encounters. Ask everyone a question that goes beyond symptoms, one that is non-threatening, not difficult to answer, though seemingly nonsensical - at first. Soon, the question will make perfect sense and the patients will enjoy a good laugh and be thinking in terms of the big picture, not only a physical complaint. With this question and the explanation that you provide, you will have set in motion a line of thinking that will enable the patient's to forget, if just for a moment, his pain, worries or malaise. And, most important, be better positioned to hear your first message about personal responsibility.
   
   Simply ask patients if they are experiencing enough DBRU equivalents! Evaluating patients DBRU daily intake at the start of clinical history-taking can open them up to all manner of insights beyond the usual history. 
   
   Readers of the E-AWR are quite familiar with the DBRU equivalent concept. No need to explain it here, as I will to the Iowa doctors. I don't suppose any will already know of this important assessment tool. However, I'm hoping that not many will soon forget it! For a refresher on the DBRU idea, go to SeekWellness.com. http://www.seekwellness.com/wellness/articles/DRBUs.htm
2. From illness to life enrichment. Broaden your scope. Think of ways to segue your current practice from something scary (illness, disease and delay of death) to something exciting, like health enrichment or life enhancement. This is another way of getting at that much overworked idea of the so-called "total patient," meaning that you should go beyond an isolated overemphasis on his or her medical problems. Yes, of course - the latter must always be fully attended. 
   
   It would not surprise me if many, if not most, of you have already began to make such a transition. Dentists have been at it for years. By "broaden your scope," I'm suggesting you consider that your career puts you in the field of life enrichment, rather than the business of medicine. A broad-based perspective and definition of the business you are in will facilitate transitions in times of change and lead to more opportunities to serve and profit as the health system evolves.
   
   In the mid-70's at the Stanford University School of Business, I learned from case studies that the most successful railroad owners were visionaries who understood and acted upon the realization that they were in the transportation business, not just railroads. It made all the difference when roads became freeways, the economy changed and alternatives to traditional ways of moving freight rendered other approaches highly lucrative while many railroads went out of favor.
   
   
3. Promote planning for personal responsibility. Becoming sovereign for one's health does not come easily for most people. It is too easy to excuse, blame or avoid accountability. To counter this hazard, invite everyone, regardless of complaints, to develop a business plan - for their own well-being. Offer to guide the process. A personal plan can be quite simple, yet remarkably effective, both for communicating the message that each person is ultimately responsible for his or her own health and for facilitating organized, successful change efforts. 
   
   Doctors can do amazing things to promote healing, but patients must be the ones who take responsibility for making healthy choices to become "weller." I believe modern medicine is a wonderful thing but there are two problems: patients expect too much of it and too little of themselves. To paraphrase JFK, you could even sound presidential in making this suggestion to your patients: "Ask not what your doctor can do for you, ask what you can do for yourself." 
   
   A personal wellness plan can be composed on a single page with key elements including a goal or two, a few objectives, sources for support, a list of barriers anticipated and brief strategies about how the obstacles will be overcome and payoffs for success. Ask patients about plan progress at every visit and offer suggestions, encouragement and guidance along the way. Of course, you should provide the forms for doing this planning -- it won't take you more than half an hour to design a personal plan process on a single sheet that all patients can modify if they wish and then utilize. (Or just copy the form that I provided to the IAFP Executive Director.)
   
   
4. Develop a wellness specialty - or two. Develop one of more special interest areas that fall in the category of quality of life enhancement. Another term for life enhancement might be REAL wellness, which is a celebration of personal responsibility based on reason, exuberance and liberty or freedom. Specialty areas might be lifestyle skill dimensions, such as exercise and fitness, nutrition, resilience-building (a positive term for stress management) or a life stage. The latter would be my first recommendation, specifically the entire area of aging well. Who would NOT be eligible for your "aging beyond belief"-type messages, sooner or later?
   
   
5. Assign homework! Conclude all patient encounters with a modest assignment that promotes personal responsibility in a subtle fashion. Call these "learning adventures" or something positive like that. You can pass along self-care and other wellness-related information in the form of articles, books, Internet site recommendations and much more. The resource base for such counseling is extraordinary, but patients are far more likely to avail themselves of it if given such direction, almost as a prescription, by their doctor. Happily, no pharmacy visit is required to learn more about the payoffs for taking greater responsibility for one's own help. But, it helps that it's doctor recommended.
   
   
6. Consider an image makeover, if necessary. The doctor's image is not as important as his or her performance, manner and a few other qualities, but it is consequential when encouraging patients to take more responsibility for their own health, unlike when the practice is restricted to treatments for chronic and acute illnesses. Doctors can assume patients will view them as role models, whether they seek to be such or not. Remember Charles Barkeley? He once complained, when asked about what message his bad behavior might be sending to his young fans, "I never wanted to be no role model." It's not an option.
   
   The fact that, to your patients you ARE a role model, like it or not, might be reason enough to shape a healthy lifestyle. If personal responsibility is a good idea, it will be evident in your presence, not just your words. One principle expressed in my first book, written in the mid-seventies, was "Examine your doctor before you allow him or her to examine you." By "examine," I meant be attentive to your doctor's lifestyle and appearance, not just what he or she expressed verbally. You know the old story illustrating the difference in effectiveness in preaching a sermon versus living a sermon's moral. A chain-smoking physician, for example, is not likely to inspire healthier lifestyle choices, no matter what advice he/she offers. Patients surely assume that a doctor who stays fit, seems cheerful and happily engaged in life and so on is more likely to supportive of the same for you.

The final six suggestions will follow in the next essay.

Be well. Thanks for your patience. Look on the bright side of life.

Domain: physical
Subdomain: adaptations and challenges

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