Comfort Zones

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I want to begin this article by stating my intent.  This is to be the first in a series of articles not so much focused on health care topics but rather the interface between the fields of sociology and medicine.  At times, such as this article and the next, these submissions may reveal some insight into how physicians approach patient care.  At times, such articles may reveal insight into what we as both physicians and patients have to deal with as a result of current medical insurance company (among other) influences.  Still other times, we may delve into philosophical thoughts or dilemmas in the practice of medicine as we know and experience it today.

But today, I want to talk about the paradox of comfort. I’m a big believer in the paradoxes of life.  They exist all around us, and you as parents know them all too well.  You love your kids, but sometimes they make you want to pull your hair out.  You can’t wait to be with them when you’re not with them, but when you’re with them, you want time to yourself.  For some of you, when you’re at your office you can’t wait to get home, but when you’re home, you view your office space as a refuge.  

Similarly, I present to you the paradox of *comfort*. We are all comfort-seeking creatures.  It’s human nature.  Who doesn’t enjoy snuggling into bed on a rainy day and just lounging, whether to read, listen to music, or talk on the phone?  Who doesn’t enjoy a nice plushy recliner chair to sink into while watching a movie in the living room?  And does anyone deny the term “comfort food”? (Which, for me, certainly conjures up thoughts of egg- and carb-rich breakfast food!) But how about mental and emotional comfort?  I’m talking about relief from stress.  Who doesn’t want to find refuge from stress?  (Side tangent: stress is a paradox in and of itself.  I agree with my dad’s teaching from my childhood – stress is a good thing, as it makes us do things we otherwise wouldn’t do, but should do; it gets us moving and going, and stimulates us.  Otherwise, we’d be doomed to laziness and gluttony, with no growth!  And a famous professional basketball coach once said: “Pain [as a form of stress] is good – it means I’m still alive”.)  Hopefully this isn’t news to you, but doctors are no different than any one else – we want to minimize stress and find comfort.  That is, expand our comfort zone.  

But there’s a constant wage of war against doctors’ comfort zones – as an industry, we are being sued for lesser reasons; we are being asked to fill out more paperwork by schools and employers and insurance companies and licensure organizations; we are being asked to know more and more about an exponentially growing body of medical knowledge with less and less time for continued self-education; we are mandated by hospitals and pharmacies and insurance companies to document seeming minutia for a variety of seemingly trivial reasons whether to minimize others’ increasing liability or to meet others’ supervising accreditation criteria; we are being asked to write for prescriptions on the basis of someone relating to his or her friend’s experience with a medication or a report on a website or because of a personal presumption that “I know it will work” or just because nothing else has seemed to work…and of course, all of that in the context of decreasing reimbursements from insurance companies.

Listen, I’m really not trying to gripe, and I’m certainly not trying to be narcissistic or build up doctors’ egos.  I have seen and heard many patients’ life stories about all the other daily sufferings everyone else goes through in their own respective jobs or as a homemaker, and I genuinely believe we’re all in the same boat.  But here’s the problem, and the reason I broach this subject today: when your doctor is dealing with this ever-shrinking comfort zone in his or her medical practice, it can directly affect you and your family.  You may genuinely be saddened or impacted by your family and friends’ battles with their own comfort zones, but I’d bet you’re not usually depending on them for a need that you or another friend often can’t fulfill in some way.  If your doctor’s comfort zone is impacted, however, you may find your healthcare affected in some irreplaceable manner

. And so I present to you this take-home message: take the time to talk with and get to know your doctor.  Let your doctor expand his or her comfort zone with you by becoming more familiar with you and your family and how you think, behave, and live your lives.  It’s a well known principle that when physicians know their patients, it is easier and faster for them to make decisions which reflect more accurate and appropriate care, are more agreeable to the patient, and lead to a higher level of satisfaction for both parties.  Sure, in this era of shortened office visits this may lead to a need for more frequent office visits, and thereby more co-pays rather than substituted phone interactions.  But consider the time and money well spent where warranted.  And as your doctor feels progressively more comfortable with you and your family, you’ll be sure to notice that your comfort zone will expand too.

Obvious qualifier: I don’t speak for all physicians – only for myself and my observations. pdf link

Fighting Human Nature, Fighting Ourselves

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As a parent, you have no doubt come to realize that a large part of parenting is being sure to set appropriate boundaries for your children, and to enforce consequences for crossing such boundaries.  Why?  Because they need accountability.

And as a parent, you also have no doubt come to realize that an equally large part of parenting is trying to instill good habits in your children, whether with regard to teeth brushing or eating meals at regular times of the day, etc, and even against their own wishes and apparent priorities of the moment.  Why?  Because it’s good discipline for them.

Accountability and discipline are not popular topics of discussion in our current day culture.  But they are, I believe, vital to our success in life in many ways, including our health.

I have historically had a love-hate relationship with my dad.  He used to always tell me how life was going to unfold, and annoyingly, in the far majority of cases, he’s been more or less accurate – that part I hated.  But whether as a result of his culture or his family or some other influence, I would say my dad is a bit of a philosopher.   This part of him I did enjoy and as I grow older, I treasure more and more.  One theme he frequently lectured me about was our human nature, and the constant battle we have against it – fighting against laziness or discontent or instant gratification, etc.  In many different layers of our lives, we go through this internal conflict.  It makes me think of the prophet Paul who writes in the book of Romans of the New Testament: “For what I want to do I do not do, but [instead] what I hate I do”.  Don’t you feel like this sometimes?  It’s like that cartoon caricature of an angel on one shoulder and a devil on the other, fighting for your verdict to act upon one impulse to act upon your better judgment, and another impulse to act upon the lesser judgment, but the one which you know seems to feel good in some paradoxical wanted-but-unwanted way.

Accountability and discipline, which I might word otherwise as “answering to someone else” and “maintaining good habits” (respectively) are, I would argue, not at all part of our human nature.  Most of us have some issue or another that we cannot ever seem to be disciplined about.  For me, perhaps the biggest impacting issue is my sleep – I always go to bed too late, depriving myself of valuable recharge-time.  (My wife would say another issue is flossing.)  Similarly, many people relate to poor disciplines with eating (too much or the wrong foods), exercise (the lack thereof), spending (excessively), television watching (excessively), or a number of other “bad habits”.  And unfortunately, though we often recognize we could do better in these regards with some encouragement, support, and help from our family, friends, healthcare professionals and others, providing a backup plan to those all-too-often-failed attempts to depend on ourselves, too often our pride, stubbornness, or some other barrier inhibits us from being accountable to those who would otherwise be of valuable help to us.

But maintaining accountability and discipline are no doubt keys to success in life, and I am more and more aware of this as life continues on.  In fact, I believe these are the tools to fight some common undercurrents in our society today which are dooming us to suffering and trials in many aspects of our lives.  The recent and the obvious: Wall Street’s crisis has reflected our lack of financial discipline – we’ve been spending beyond our means, overextending our credit, racking up debt.  The chronic and sometimes less obvious: obesity will soon be named as this nation’s #1 cause of preventable death and morbidity, overtaking tobacco abuse, reflecting our lack of eating and exercise disciplines – we’ve been eating beyond our limits, overextending our sedentary lifestyles, racking up fatty tissue.  I would argue that accountability and discipline are what we need to restock in our lives in order to battle the American society’s overwhelming cultural drives toward impulsivity, instant gratification, and the “big and more is better” mentality, all of which undergird these two stated challenges, among others, in our lives.

With regard to your and my personal health, accountability and discipline are no less important.  In this culture, where not fighting against the grain leads to the default status of obesity, maintaining disciplines of exercise and healthy eating habits are essential.  And, knowing that the majority of us can’t rely on ourselves to maintain such disciplines over larger periods of time (not just in March, after the New Year’s resolutions have faded, but from year to year, season of life to season of life), seeing your doctor for regular physicals is a healthy form of accountability, as you step on that scale and engage in an evaluation of how your living has manifested amongst your body organs and tissues.  (As a side note, this is not a plug to drive more office visits.  It is a commonly held notion that health care providers of all sorts, including physicians, are notoriously poor at being held accountable ourselves for our own health, including having regular physicals.)

And so I urge and challenge everyone today, myself included: let’s be willing to be held accountable for our health, and strive for disciplines in our exercise and eating lifestyles.  Let’s be willing to look ourselves in the mirror and ask the hard questions, and engage in the internal battle against our human nature.  Over time, the battle lessens, I assure you.  Let’s apply to ourselves some of those parenting skills we’ve developed and applied toward our children by allowing someone else to “parent” us in some of our health habits - let our doctors and friends who are health-conscious minded be part of our team of encouragers, life coaches, and cheerleaders as we seek a healthier mind and body.  Apply some of those same learned parenting skills by remembering the importance and rewards of consistent and healthy habits, and with time, let these disciplines be a model for others, as we win over our human nature and take better control of our lives.  With time, who knows, maybe some of these principles will spill over into other parts of our lives, and improve our financial, relationship, and other lifestyles too.