The most important verb in our health crisis

There was great commentary on my last post. Thank you all. I learned a lot from your words. This is how it’s supposed to work here.

One comment in particular has stuck with me. It concerned the formation of a how-to be-healthy booklet. An information manual, if you will.

I’ve thought about this many times before. Bookstores have entire sections of self-help books. There are manuals on healthy cooking, healthy living, healthy this and healthy that.

What I was thinking about is something simpler, more to the core of the current crisis in health.

I looked up the verb, “to choose.” (I do this a lot more than I used to. It helps me understand things.) What I found struck me:

1. pick out or select (someone or something) as being the best or most appropriate of two or more alternatives:
2. decide on a course of action, typically after rejecting alternatives.

This is it. I think it’s all about choosing. To be clear, I’m not placing the burden of choice on just patients. It’s everyone, from individuals, to doctors, to medical organizations and society as a whole. Together, there has to be a selection. We have to choose health.

On an individual (patients) level, one has to choose the healthy way. This is not complicated. The table of health has only four legs: good movement, good nutrition, good sleep and good attitudes. Every literate human in the Western world knows the basics. They just have to choose.

Doctors also have to choose. We have to make a selection. Do we select the easy course, which is to ignore the elephant in the room and keep making marginal changes in medicines, perform procedures and surgery? Do we choose to care enough to address the root cause of disease? In my case, do I ablate AF in a patient who has AF solely because he won’t stop the nighttime cocktails, slow his work schedule, go to bed at a reasonable hour and use his sleep apnea apparatus? Does the vascular surgeon keep bypassing blocked blood vessels in the patient who keeps smoking? Do we care enough to choose to engage the root cause of this crisis?

Educators have really important choices to make. For me at least, it’s a true human tragedy when children spoil what nature gifts them: their flawless health and beautiful bodies. Those who have dedicated their life to the well being of children must reject the path we are on, and select a healthier course. A commenter made reference to eliminating physical education from schools. It’s risky to use metaphors, but is that ridiculous choice not a metaphor for the entire health crisis of this nation?

And finally, Society must choose. The choices we have made here are highlighted when one gets off a plane from Europe. The people of the United States of America have made an obvious choice about their health. If we care about our vitality, there must soon be another selection. Anything more complicated than a simple choice obfuscates the problem. Americans must decide what it will be. Will we continue on the path we are on, or will someday, society wake up and decide that healthy is normal?

To choose.

Selection of a path.

Rejection of an alternative.

It’s not about restricting biggie drinks, closing fast food restaurants or stopping the addition of sugar to bread. It’s about making simple choices.

Sorry. This is one of the many reasons why I am just a doctor and not a famous self-help author.

JMM

Comments

  1. Jeff says

    Move enough, eat only enough, sleep well, view yourself and your world with equanimity.

    These are not always enough.

    I was the second fastest kid in grade school. Kids just do what’s fun. I just stuck with it – for the next fifty years. Not really a “choice”, was it? I’ve weight-trained as well, but nothing quite as vigorous or stressful as bike racing. :-)

    Result: Labile hypertension, high LDL cholesterol (albeit high HDL as well), paroxysmal AF in my late fifties.

    It turns out that my appetite has always been for what can only be described as the Mediterranean diet — with nuts. Yummy. Not really a “choice” either. Forty years of eating well — as far as can be told from any medical consensus.

    Results: prediabetes and lymphocytic colitis. This involves a catch 22. Foods good for diarrhea are high glycemic.

    I’ve ALWAYS slept well. eight hours, more-or-less, straight through.

    I’ve NEVER been overweight. Always slim. Always hardbody.

    Recently there have been real choices:

    Have the AF ablation NOW, instead of waiting for a greater medical understanding and technical improvements to come along in some distant, unforeseeable future.

    Not to take statins — increased risk of diabetes and muscular debility are too much to take on. Besides, what is true about cholesterol? Does a high total really count as bad? Does a good ratio really count as good? Is it even the cholesterol? Inflammation?

    Which hypertension medications, keeping in mind the many side effects that can exacerbate other existing conditions?

    Not simple.

    These are the choices I must face, now that the “simple” ones have not worked.

    My equanimity is challenged.

    Might you have a booklet for the exceptions such as myself?

    • TruthBeTold says

      Like, Jeff, I am also a lifetime athlete in my mid-50s who has recently learned that, despite making all of the right choices (recommended by Dr. J), you can’t choose (or alter) your genes.

      • Don L says

        Same here. And now that my afib has been corrected and I have started to resume some of my former activities, I find out that I have a bad hip that will probably need to be replaced.

        Still, it could be a lot worse. :-)

  2. Jeff says

    Each person in a physician’s practice is an individual. Each individual that makes up a society is just that. I’m sure that the four basics would be critical for most individuals to face up to and make decisions about.
    Most.
    The protocol of healthy choice.
    I’ve had to fight the idea of protocol these last few years. It’s the easy way for physicians. Whenever it comes up I have to force the doc to see me as an individual. It takes time. It’s expensive. There’s waste. It’s emotionally draining. I find it to be necessary for a positive outcome

    So, my above comments are simply to point this up by example.

  3. says

    For Jeff – NO easy answers. Despite making good choices, I understand the difficulties you’ve had. Your example is appreciated – and you clearly illustrate that “making good choices” won’t fix all. You also make the excellent point that patients/people are individuals. They are all different. There is no “protocol” that fits all. That said – I think integrated in your insightful comments is how the clinician who does care for the patient profile you present needs to be a good listener who is willing to work with the patient to help in deciding on the best choices given circumstances. Just following “guidelines” is not what is needed – and I would not go to a physician who just “follows guidelines”. THANK YOU for writing Jeff!

    As per Truth-Be-Told – You can’t choose your genes!

    Last – I’ll add a comment to Dr. John’s post. Not all of Europe is what it once was in terms of “lifestyle examples”. Much of Europe (and the world) follows the U.S. – and there is much more obesity and sedentary lifestyle in certain places in Europe than there ever was in years past (certainly compared to when I lived in Europe years ago). And not all of the U.S. is prone to making poor lifestyle choices. I was born and raised in New York City – but moved away over 40 years ago. Return to that city a few years ago was tremendously gratifying to me because on the whole, the population featured VERY FEW significantly overweight individuals. On the contrary – it seemed everyone in Manhattan walked! Fruit stands were EVERYWHERE on the streets. People seemed fit. What a revelation!

    • Jeff says

      You’re welcome, Dr Ken. But, consider:
      I’m a guy like any other – basic human animal.
      Except for my attention to the Four Important Things …FIT :-)
      and except that, nonetheless, I’m failing.
      Writing us off as having unfortunate genes – without being able to point to them and say why – is an easy solution for you to have “chosen”.
      If you consider us outliers as a valuable resource and do the hard and expensive work to figure out why our various systems fail early – having always done the four things right – then maybe you will have discovered something more basic, more profound, about the nature of human wellness.

      • says

        Jeff – I believe there has been some misunderstanding with what I wished to convey. Please let me clarify the 3 messages that I meant to convey:

        i) You are not an “outlier” with unfortunate genes and predetermined destiny that precludes positive result.

        ii) On the contrary – You are an optimal patient because you are informed, are obviously motivated, and you already work toward favorable lifestyle choices.

        iii) I believe you can be helped once you find a capable clinician willing to work with you (rather than insisting on set protocols). I believe that between the two of you – the chances are good that there can be meaningful improvement in your overall health situation.

        • Jeff says

          Thanks, Doc Ken,

          ii) I know. It’s not easy work.

          iii) I found an electrophysiologist who did the ablation. So far so good.
          My cardiologist is coordinating with my gastroenterologist to be sure cross-purposes don’t prevail.
          I don’t eat anything white and my GP keeps me on my toes with regular A1c tests.
          The team seems to work pretty well.

          i) Wherever I turn, I’m told I’m unusual. Outlier, whatever – I don’t fit the “norm” or “average”. It seems to me that profiles such as mine might provide an opportunity to see more deeply into the nature of health and aging exactly BECAUSE of my exceptions. In science or math you always look at the extremes, or exceptions, to understand.

  4. says

    Healthy choices involve understanding long-term consequences from short-term decisions. In a society where people expect rewards immediately how capable are patients of making those healthful choices without guidance? As teachers (Docere, latin to teach) our job is to partner and help them make those choices. But all quarters of our culture conspire against us, from the time allowed to spend with patients to the corporate greed that consumes us.

  5. Joe says

    On doing enough – nothing is ever enough, if we define enough as never having a health issue. We all die from something eventually.

    Too many suffer or die from something that could have easily been prevented.

    Some of us die from something no one could do anything about. Bad stuff happens, even when everyone does everything right. Bad stuff happens to good people, and it’s not fair. Those people aren’t an exception. Unlucky? Maybe, but mostly it makes them human.

    Having some understanding and expectation about the arc of our lives is another characteristic that makes us human.

    Good choices give us the best chance for a long and healthy life, given the cards (genetics, environment, luck) we’re dealt.

    On being average – A statistician runs across a man with his head stuck in a block of ice and his feet on fire. The statistician walk by and waves. A friend later asks “Why didn’t you help that poor man?” The statistician replies, “on average, he was doing just fine!”

    • Jeff says

      Joe, brilliant about the statistician! We’re each of us unique. No one is average.

      I do, though, consider myself to be a member of the community of humanity, and, yes, my “exceptions” are part of that. Are they outside typical expectations because real anomalies happen or because the medical community does not yet understand them?

      What ARE the good choices?
      It’s hard to argue with Dr John’s four macro-choices. I wouldn’t try. But what about the micro-choices?

      We were told at one point to keep out of the sun and use the highest SPF. Now we’re seeing that the resulting low vit. D results in more cancers – including, ironically, skin cancers.

      We were told to avoid butter and use vegetable margarine instead. What health harms came of that due to the hydrogenated fats and trans-fats that we’re told of now?

      Should we drink moderately? Is it for the benefits of the bit of alcohol, or for the resveratrol? Money is being made.

      Salt is bad. Not bad. Only for some.

      Calcium supplements now clog our arteries.

      So much is simply unknown. Should we act vigorously on what we THINK we know, as above? Or wait until it’s known for sure?

      I don’t know.

  6. says

    Regarding “choice” – you might find this post useful:

    http://www.nirandfar.com/2013/07/why-behavior-change-apps-fail-to-change-behavior.html

    An excerpt:

    In fact, a recent meta-analysis of 42 studies involving over 22,000 participants concluded that these few words, placed at the end of a request, are a highly-effective way to gain compliance, doubling the likelihood of people saying “yes.”

    What were the magic words the researchers discovered? The phrase, “but you are free to accept or refuse.”

    The “but you are free” technique demonstrates how we are more likely to be persuaded when our ability to choose is reaffirmed.

    • says

      Beautiful. Thanks so much. I loved that post. It’s so true.

      I’m tingling with delight, because I start almost all my medical decision discussions with verbiage like this:

      …It will be your decision what to do

      …Multiple paths exist here

      …Option A is this, Option B is that, and so on.

      No patient of mine “has to” do anything. I don’t see my job as being their parent, and doling out “haftas.’ I see my role as a skilled and benevolent adviser. Patients are the experts in what is important to them.

      I wish more humans made wiser choices when it comes to health.