The patient looked at the one-page guides on diet, nutrition label reading, and exercise recommendations that I’d given them as we went over those topics. They, like so many of us, could improve their diet and exercise routines to optimize their health. The patient stood, ready to leave the exam room. They paused before we entered the hall. “Thanks for caring. You’re the first doctor who talked about all this,” they said.
“Of course, that’s my job!” I said. I let their comment sit. They were over 50 years old. What had their doctors talked about throughout the years if not these topics?
I reflected on how exciting and challenging it is to be a mechanic of the human body – something I’ve come to consider myself as I settle into my work as a primary care physician. I think the analogy best describes the role I play in my patients’ health and lives.
As a mechanic of the human body, I don’t have control over many things.
- I can’t control the make or model (the body type, age, or genetics) my patient has.
- I can’t control the road they drive on or how that road is maintained (the patient’s life journey).
- I can’t control the obstacles and dangers on the road they follow (the unexpected challenges that are the metaphorical equivalents of a deer jumping in front of their car or a patch of black ice).
- I can’t control how much money they have to fuel, maintain, and optimize themselves.
- I can’t control how they fuel themselves (food or otherwise) and how often or at what speed they go for a spin (exercise).
- I can’t control how the world treats them (the metaphorical equivalents of sunshine on paint and potholes on tires).
- And I can’t control if my patient implements the maintenance and repair suggestions I give them (the lifestyle tweaks to optimize health, the medications, and so on).
As a mechanic of the human body, I can control a few critical things.
- I can control what I say about my patient’s health.
- I can control when I give advice, allow reality to just be, or offer praise for success.
- I can control where I recommend we focus in terms of health optimization and next steps for improving or maintaining their health.
- I can control how I listen. How I talk. How I behave.
Health is complicated. It’s not just about what a person does, though work, exercise, diet, and relationships play a huge role in health. Health is a lot about luck – the genetics, place of birth, and family culture and wealth fate gave a patient. Health is a lot about environment – exposure to toxins, discrimination, kindness, and education. Health is a tiny bit about interactions with the healthcare system and medications. That said, most of what I listed is out of a patient’s control. This means, while many health challenges are rooted in genetics and environment, the only health improvements that are possible are what a patient does (from taking their medications to increasing exercise, as examples).
Alleviating and eliminating most medical problems begins with making lifestyle adjustments. There are few people in the US who can’t improve something about their lifestyle to further optimize their health. After lifestyle we have medications, procedures, and surgeries. But we don’t have medications, procedures, and surgeries for everything…which means… sometimes… the only thing a patient can do to improve their health is make the best lifestyle choices they can.
When I reflected on my patient’s comment, I was not surprised that lifestyle changes had not been a huge focus of their previous discussions with doctors. Healthcare is rushed. But, more than anything, lifestyle is the hardest thing to teach and talk about. It is harder to explain and change patients’ lifestyles than it is to prescribe medications. It’s fitting that lifestyle is hard to teach because lifestyle adjustments are also the hardest thing for patients to do consistently. Just as it is hard to follow traffic laws and speed limits every time one drives, making the best decision for one’s health every time one acts requires vigilance and strength. It takes constant effort to choose the healthy option and resist the other options. As a mechanic of the human body, I can’t make lifestyle choices for my patients. All I can do is provide maps and information to help them decide how and where they wish to go. Challenges and all, I’m excited and humbled that my patients chose me to join them on their health journey, one-page educational guides and all.
