Tough days in clinic often stem from the challenges of counseling patients on how to adopt healthier lifestyle habits. Habits are the molecules that make up our everyday lives. It’s the little things that count, and yes, even the tiniest things can count so much. Something as seemingly trivial as posture can have dramatic effects on muscle tension and back pain. Something as seemingly inconsequential as diaphragmatic breathing – those deep intentional belly breaths – can have profound physiological effects on how we cope with stress and anxiety. This is perhaps one of the greatest frustrations I have as a medical student (and very soon-to-be doctor): learning the nuances and confronting the challenges of guiding patients toward changing their habits.
As clinicians, we can fall into the trap of trying to change our patients. The truth is that we clinicians (no matter how passionate or deep are intentions are) we cannot force our patients to change; we can only guide our patients in the direction of health. The goal of truly patient-centered care is respecting the values of our patients, listening to them, understanding their point of view and probing their motivations, and asking the tough but important questions: why do you do what you do, what value do you achieve from doing this, what is important to you, are you living your values? By collaborating with patients on their health journeys and addressing root motivations from the patient’s perspective, change just might be possible.
To be healthy is a lived experience, it’s a conscious choice everyday.
Early in my medical school training, I was introduced to the transtheoretical model of change (TTP), an approach to behavioral change counseling supported by decades of research in health psychology. This framework for change states that individuals move through five stages of change: precontemplation, contemplation, preparation, action and maintenance. It assumes a temporal dimension of behavioral change: change occurs over time as people move to and from different changes. As clinicians, we need to assess a patient’s stage of change, and work from there: we explore that space with them, ask lots of questions, listen compassionately and help them clarify their health goals.
Over the years, I’ve developed habits both consciously and unconsciously that helped me create health. It took years, and that’s what many people may not understand: health takes work.
In order to deepen my empathy with patients, I occasionally reflect on what led me to change my behaviors. And the root cause was partly because of my personal experience dealing with family illness, and coping with the stresses, frustrations and devastations of living and loving a family member with multiple chronic and debilitating diseases. It’s as if I saw what could become of me if I didn’t take care of myself, and I was emboldened to change. The change started small: a few jogs around the block, slowly cutting down on refined sweets, and cutting out soda. And as I progressed into my health journey, I was more open to enhancing on the health I achieved: I become more adventurous and became a vegetarian, briefly took up indoor rock climbing, and enrolled in a ballroom dancing class for exercise. When I started medical school, my health intensified in a sense because I wanted to model healthy behaviors for patients, and I also knew that maintaining my health meant that I could give and do more at work and in my personal life. Over the years, I’ve developed habits both consciously and unconsciously that helped me create health. It took years, and that’s what many people may not understand: health takes work. To be healthy is a lived experience, it’s a conscious choice everyday, and it’s one I hope to help patients see the importance of.
What are your habits and what do they say about you?