Don’t give up on your patients, some will absolutely amaze you

Do you, or people you care about, have a chronic medical condition? There are all kinds of chronic diseases, but the ones that are most aggressively killing us—and the health care system—are heart disease, diabetes, and metabolic syndrome (a deadly combination of excess weight, high blood pressure, increased cholesterol and elevated blood sugar). These are all primarily lifestyle diseases and cancer should probably be on the list, too.

I felt sad after a recent gathering of physicians I attended. I was really disappointed by the negativity with which they talked about patients with conditions like diabetes and heart disease. They didn’t believe that lifestyle interventions worked beyond a few months of initial effort, and talked about these patients as lost causes.

I know I’m a bit (a lot?) of a Polyanna, but this really upset me. I got a degree in Dietetics before my M.D., and have been obsessed with preventative and whole-life medicine for over two decades now. Yet at this meeting, since the specialists who were present agreed with the general opinion that these patients were a lost cause (and I’m always open to the possibility that I might be wrong or excessively optimistic), I wondered if my beliefs about disease reversal had recently been proven to be incorrect or naive.

I did some research when I got home, and sure enough, found numerous sources that cited lifestyle change programs that had been successful in reversing diabetes and heart disease.

The next week, in a cosmic coincidence that wasn’t a coincidence, I found myself in New York City at Social Media Week, listening to Dr. Michael Roizen, Chief Wellness Officer of the Cleveland Clinic and one of America’s top docs. He spoke of the epidemic of chronic disease, and the disastrous impact it has had on the American economy, even to the point of forcing the loss of manufacturing jobs to other countries.

He also talked about how to reverse, or dramatically alter, the course of aging and chronic illness. He discussed incredibly encouraging data which supports the idea that the bodies of people who are considered medical “lost causes” are stunningly capable of reversing the course with the right kinds of nutrition and lifestyle changes.

As a medical doctor, wellness expert and life coach, I constantly talk to people about how to create previously elusive (yet often desperately needed) change. My strategy is subtly different for each individual, because each has a unique multitude of different reasons why they continue to make choices that harm their bodies or their lives.

As Roizen pointed out, “our behaviors aren’t changed by data, they’re changed by emotion.” Giving people information is a start, but it isn’t enough. That’s largely why hordes of people with diabetes and heart disease have changed so little about their lifestyles (or tried and failed), even after going through well-intentioned public education programs. Roizen described a complex wellness program that they’ve created at the Cleveland Clinic which has proven to be powerfully effective in improving the health of thousands of people.

That’s beyond the scope of this post, though. What I’d like to convey more than anything is the need to give hope back to the sufferers of chronic disease. They are not a lost cause. There is a very big difference between telling someone the reality of where their lifestyle choices are currently taking them, and telling them that there’s no hope and to prepare for the inevitable worst.

I work in a clinic where patients are seen by multiple physicians. The other day, I made a man cry. He’d recently been diagnosed with diabetes, and when I saw him he’d come in for a renewal of his new prescription.

I started talking to him about lifestyle change, and he interrupted me and asked: “What’s the point? The other doctor told me I have diabetes and that I have it for life, there’s not anything I can do about it and it’s just going to get worse. I may as well keep eating what I want to.”

It was all I could do not to shout my response.

“This is an opportunity!” I told him. “You just got diagnosed and yes, if you continue eating and living the way you have, it’s not going to be pretty—you might go blind, your kidneys might fail, all that is true. But Diabetes is potentially reversible, and you can take your health back.”

He swiped at his eyes as he started to cry. Tears of relief. We talked about his diet: he was drinking an insane amount of soda, ate hardly any vegetables, and ate a ton of fast food.

When I saw him a month later, he had kicked the soda and fast food, had frozen vegetables in his freezer, and told me “I feel so great, I can’t believe how much energy I have. I can think clearly, it’s amazing.” Some of that may be from the medication having normalized his sugars, but I have no doubt that it was also because of the key dietary changes he’d made. He thought so, too. He thanked me again for having given him hope, and told me, his eyes gleaming, that he was determined not to let this disease win.

The cynics might counter by saying that in six months he’ll have given up and will be back to his old ways, but I don’t care. I believe there’s a good chance he might prove to be the exception. Regardless, there’s still no excuse for not giving people hope.

You never know who has that kernel of greatness inside, who is going to be the 68-year-old woman with severe heart disease, on 26 medications, near-dead in the ICU, who goes on to be a Guinness Record Holder for fitness (another story I heard, from Dr. Pam Peeke, at Social Media Week).

The wonderful thing about some people – and you never know who it will be—is that just when you’re ready to give up on them, they will absolutely amaze you. So don’t give up on people. Whether you’re a doctor, or a friend or family member, believe in them and speak hope into their lives, whenever you can.

Susan Biali is a physician and author of Live a Life You Love: 7 Steps to a Healthier, Happier, More Passionate You. She blogs at her self-titled site, Dr. Susan Biali, MD.

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  • http://www.facebook.com/people/Debbie-Thompson/100000225773725 Debbie Thompson

    Alot of things get blamed on “lifestyle” and “genetics”. I have late stage Lyme Disease and Rocky Mountain Spotted Fever.  My kids were born with Lyme, because I wasn’t able to find out what was wrong with me, until I was near death. I heard “in your head” for over 20 years. These days, I consider “lifestyle and genetics” to be nothing more than “blame the victim”.

    • http://www.susanbiali.com/ Dr. Susan Biali, M.D.

      Obviously there are exceptions to every rule – but what do you think of the millions who consume processed and fast foods and drinks that aren’t fit for human consumption? Should they just continue, because “lifestyle doesn’t matter”? I think it’s extreme to say that recommending lifestyle changes is blaming the victim, it’s actually giving power to someone victimized by ignorance or bad habits. It’s also extreme to think lifestyle change can solve everything. It’s a balance. But every single human body, no matter what the other circumstances are, would benefit from a healthy lifestyle in addition to any other diagnosis and treatment they require. I imagine someone with Lyme would still do better if eating well?

  • http://www.facebook.com/people/Jackie-Swenson/100000046998781 Jackie Swenson

    Please don’t give up on your patients!  It took my husband almost 10 years to finally have some confidence in his diet and exercise routine.  He had two stents installed at the young age of 45 – my late Mother-in-law was diabetic and had quardruple bypass in her late 60′s. She lived till almost 81 – spending her last 6 years in the nursing home due to Alzheimer’s.  Mother-in-law’s long, torturing years must have got hubby’s attention.

    Hubby did not believe he could lose weight – as it had always come back.  But this past year he seems to have found the key to it  (had quit drinking soft drinks more than a year ago and stick to a walking routine) and has now dropped about 8 lbs.  He will reach his target weight in probably less than a year if he can lose another 7 lbs.  He began to enjoy the breakfast oatmeal about six months ago having seen me enjoying it for several years.  I put milk, yogurt, strawberries, blue berries, rasins, walnuts, oranges, apples and sometimes grapes in it. 

    Now the thought of greasy hamburgers makes him want to throw up…  And it actually upset his stomach the other day when he politely ate one that was offered by one of his golf buddies. 

    • http://www.susanbiali.com/ Dr. Susan Biali, M.D.

      What a fantastic story of hope, Jackie! Thank you.

  • http://twitter.com/TheUnorthodoc Dr. Cory Annis

    Before I went to Medical School I worked as a PA for the world’s most boring and brilliant internist. I heard he say the same thing again and again to people who didn’t appear to be listening. I asked why he bothered. He said, “Because you never know when it’s going to stick and for whom. I don’t want to miss that moment.”

    Now 30 years into my practice of medicine, this “boring” and steadfast philosophy has provided me more moments of awe than anything else I do or say. If I start by always assuming its possible for everyone to change and hold that expectation out each the I see them, the moment their light bulb finally switches on is an awesome triumph for both of us…and reason to arrive at the office every day.

    • http://www.susanbiali.com/ Dr. Susan Biali, M.D.

      I LOVE it, what a fantastic mentor.

  • http://twitter.com/MakeThisLookAwe MakeThisLookAwesome

    I think what this article points out is something huge… the doctor that diagnosed him *never* talked about what he could do to manage his disease! That’s APPALLING to me. Isn’t that in the job description of being a doctor? Why did it take him coming to you to finally hear his options? Shouldn’t the diagnosing doctor have given him that? How are patients supposed to make good decisions when they don’t even know what their choices are? 

    • http://www.susanbiali.com/ Dr. Susan Biali, M.D.

      Most doctors haven’t been taught medicine from a preventive point of view, I know I wasn’t. We’re taught to diagnose and treat, primarily from a pharmacological standpoint. Many of us are also overwhelmed with large numbers of patients (with less and less time available to spend with each) and are burned out, I can relate to this personally. Who knows what that doctor’s reason was that day, but it’s very common. We do have diabetes education programs, for example, that many patients are referred to (to learn about nutrition etc.), but still I think we fall short in the hope we could give to people re. their potential to dramatically turn things around.

  • http://www.facebook.com/people/Jackie-Swenson/100000046998781 Jackie Swenson

    I thought ‘genetics’ is supposed to exonerate the patient.   I was blamed for my illnesses all the way till I was 30 when a life-long brain tumor was finally ‘discovered’.  Less than 10 years later, my Mother was diagnosed with NHL, another 10 years, my 2nd Brother was diagnosed with colon cancer.  He’s the healthest of 6 siblings – hardly even catches a cold.  And he’s the one (and my Mother :) used to chew on me about not taking care of myself.

    By that time I’d already been through breast cancer twice.  I got online and found a cluster called HNPCC (Heretitary Non-polyposes Colon Cancer) which matched exactly the types of cancers we had.  By then I’d already had genetic testing done.  And my doctor agreed that I should have a prophylactic hysterectomy/oophorectomy.  Now I’m feeling better than ever!

    Many members of my breast cancer support group carry the BRCAI or BRCAII genes.  There are people who are predisposed to certain illnesses such as obesity.  Although it is a worrisome situation now that we are having so many young kids being obese…  Hopefully ‘My Plate’ and Mrs. Obama’s ‘Let’s Move’ program will have some impact in school children.  We can’t let the current treand continue!

    • http://www.susanbiali.com/ Dr. Susan Biali, M.D.

      Of course there is a genetic component to disease, for some more than others, however we know now that lifestyle choices have a significant impact on gene expression. So while genetics need to be taken into account, there are things you can do to improve your odds of health in spite of genetics…

  • http://www.chirorehab.net/blog/ Robert W Ferguson, DC, FIAMA

    I think we always have to be open that the patient can do
    better than we initially expected.  I
    have had several patients that have come in with chronic back conditions
    already with a history of several back surgeries.  My first thought is there is no way I can
    help this.  Then the patient does his
    exercises and follows his treatment plan.  I see them progress more rapidly and
    completely than I would have ever dreamed of.

    I completed my certification for acupuncture.  Initially I was somewhat skeptical of some of
    the benefits to acupuncture.  We started
    having several patients coming in with sinus conditions and all I did was
    stimulate acupuncture points in the ear. 
    These patients then came back the next day saying their sinuses were
    clear.  We even had one patient that was pregnant.  She had chronic sinus problems and
    migraines.  She did not want to take her
    medication for fear that it would harm her baby.  All we did was one session and her chronic
    sinus problems of over two months went away.
    Robert W. Ferguson, DC., FIAMA
    http://www.chirorehab.net 

  • http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V

    While it’s a good article overall I have an issue with trying to blame the economy on chronic disease. Like this comment from the referenced lecture seems totally ridiculous to me:
    “He spoke of the epidemic of chronic disease, and the disastrous impact
    it has had on the American economy, even to the point of forcing the
    loss of manufacturing jobs to other countries.”

    The manufacturing jobs (as well as all other jobs) were lost because of a) people in other countries willing to do the same work for fraction of the salary and no benefits. No matter how healthy the Americans are, they cannot compete with a person willing to work for $500 a month or less in a sweat shop in China with no benefits. Not even healthy 20-something athlete can compete with that. and b) technology that reduces the need for people’s doing manual tasks. Nowhere in any economic papers do they even mention chronic diseases. The jobs are’t exactly lost to European countries or Japan, are they?

    IT jobs are lost as well as call center jobs for the same reason — there are people who can work for much less. Even healthy engineers who haven’t taken a single sick day in the past 10 years and don’t take a single prescription drug, find it difficult to compete with someone who is willing to do my work for a fraction of my wage.

    Methinks the doctors should keep to what they know best – i.e. medicine, and leave economics to those who know it.

    • http://www.susanbiali.com/ Dr. Susan Biali, M.D.

      I appreciate your point – and wish I had the graphs that Dr. Roizen showed to illustrate his point. I agree that of course it’s not this simple, it is a multi-layered problem. But there is no doubt that a healthy America would be a more econonically competitive nation (how could it not be?), and I thought Dr. Roizen’s illustration of this to be very thought-provoking. Don’t you think that if corporations had to spend dramatically less on health care insurance costs, it would make a difference?  Especially if billions can be saved on health care costs by simple lifestyle and nutritional change. It’s win-win for both the people who are enjoying better health, and those who would have to spend much less to keep them healthy.

      • http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V

         The graphs will be interesting, but correlation isn’t causation. If you read any article in economic journals, the health doesn’t even enter. Also, while being healthy is its own reward (which one of us wants to be sick?) study after study showed that prevention doesn’t reduce costs. Not a single penny, much less billions. Even smoking which is the biggest risk factor of them all – for the simple reason that smokers die sooner. 

        Healthy of not healthy nobody in the US can compete with people willing to work for under $500 a month. Also manufacturing jobs – which tend to be jobs that require more physical activity – aren’t the only jobs lost. Call centers, IT – virtually any job that can be done remote can go abroad. US workers who are not employees of companies but contractors (i.e. hired by a company for say a year contract that can be extended by another year) don’t get health insurance, but their jobs are often the first to go.
         

  • http://www.facebook.com/profile.php?id=1346750257 Letitia Parkinson

    This is very misleading about diabetes.  Type 1 and type 2 are very different diseases.  Type 1 is an autoimmune disease and can strike anyone, regardless of how healthy.

    • http://www.susanbiali.com/ Dr. Susan Biali, M.D.

      Yes, you are right – since the predominent epidemic in our society is lifestyle-related Type II Diabetes (I almost never see Type I DM in my practice), I assumed that the distinction was obvious. My apologies, I should have specified.

  • http://www.healthasahumanright.wordpress.com/ Erin Gilmer

    Thank you, Dr. Biali for this post.  I have been crestfallen to find many doctors who shame and threaten patients who have chronic diseases – that if they don’t immediately do as they’re told, they aren’t worth the effort.  I would be one of those lost causes.  And you are completely correct, the decision goes much deeper than the facts – it’s emotional and involves many facets that most doctors won’t take the time to listen to.  So I applaud you for reminding doctors to really try to listen, address the patient as a whole, and not give up.  I wouldn’t be where I am were it not for Dr.’s Satish Garg and Timothy Vachris who wouldn’t give up on me.

    • http://www.susanbiali.com/ Dr. Susan Biali, M.D.

      Wonderful Erin – I am SO glad for you! Thanks for your comment and for the positive reinforcement.
      Susan Biali, M.D.

  • http://twitter.com/DiNovia DiNovia

    Dr. Biali,

    Thank you for an article that is filled with hope and that also highlights some needed changes in the traditional healthcare model.  Chronic disease is on the rise.  That is irrefutable.  I have four documented auto-immune diseases and am being evaluated for a fifth.  Do you know what this means for me, an educated, employed administrator in a health care setting?  It means endless trips to specialists who treat only the body part or symptom involved.  It means explaining my story over and over to different doctors who do not care about anything but what affects the body part they are interested in.  It means exhausting myself and others with constant trips to the lab, to specialty clinics, to xray…. 

    When I ask my doctors how we can work together as a team (meaning myself as a collaborative member of my health care team) to help me retain some normalcy and functioning in my life. I am met with a range of responses from The Blank Stare of Incredulity all the way to hostility.  I have heard, all my life, variations of the “It’s all in your head” diagnosis and STILL do, even though I have documented and complex diagnoses.

    That phrase and the others like it are a clear and devastating barrier to any possibility of change, whether initiated by me or not.

    I see the need for several changes here.

    1.  Change the health care appointment model from didactic to collaborative with the patient as a valued member of the team.  Make the depression diagnosis based on actual, clinical diagnostic points rather than as a catch-all for non-specific symptoms that temporarily do not make sense.

    2.  Change the health care team model from PCP + specialists to a team of caregivers who communicate about the entire scope of the illness and its effects on the entire organism/person.

    3.  Create an auto-immune specialty so that sufferers of auto-immune diseases can see a smaller team of caregivers and get better, more consistent care from providers who are trained in the entire scope of the illness, rather than on just one area of the body.

    I would be over the moon with a provider who sat down with me, heard my entire story, and began the follow-up conversation like this: “I hear that x, y, and z are the main issues you are concerned with.  I am also concerned with c and d.  I can help you with y, c, and d.  Let’s talk about those first, come up with a plan that we both feel is reasonable, and then you can tell me any ideas you have for improving x and z, because I am going to be of limited help there.  You will have the most potential for change on those items.”

    I would like to say that I am not giving up on my care providers but after 25 years of feeling unheard and dismissed and shuffled from one provider to another, I’m starting to feel like giving up on providers is on the horizon.

  • Sapphire Storm

    Beautiful article~ I appreciate your attitude and your words! As a woman who is about to study for a master’s in public health, I find your beliefs hopeful and informed; you speak to the heart that beats in the center of public health (I believe); because we have to reach the individual person and not look at him/her as a bag of symptoms and outcomes.
    Thank you!

  • Anonymous

    Thank you for this post.  Doctors have no right to take hope away from patients.  They must never give patients false hope, but they also must never steal patients’ hope.  Hope is a powerful medicine.