A resident once offered me this piece of advice: Find mentors whom you admire. Not just for their rapport with patients, but also for their lifestyle, their hours and their family life. Make goals that you know to be realistic because someone has already accomplished them.
My question now: Why stop there? Why not share that ounce of brilliant advice with our patients? Why don’t we link older, successful patients with diabetes with diabetic patients in their early twenties? How could it benefit their care to see that turning sixty is not necessarily a harbinger of heart disease and dialysis? The statistics are out there, in our exam rooms and on the Internet; we can recite the incidence of blindness and kidney failure repeatedly to our young patients. I argue that introducing them to a person who has controlled their blood sugars and managed a healthy and fulfilling life is a far more powerful motivator than fear alone.
As a student, I cannot help but wonder if inspiring resilience in patients whose diseases I may never live with is forever beyond the scope of my skills. Fortunately, this specific skill may not be something I, as a physician, will need to provide to every patient to give him or her the best care, as long as I utilize tools that are better qualified to address this need. Sites like Crohnology, PatientsLikeMe, DiabetesMine and the afternoon nap society all exist on the Web to bring together patients with similar illnesses to illuminate a shared experience. As our population ages and more and more of our patients have an online presence, these online patient networks may become an increasingly valuable resource.
Consider the positive impact of asking if our chronic disease patients are networking with other patients and of knowing good resources to which we can direct them. Not only does this acknowledge a place for patients on the provider side of the team, but it also allows patients the opportunity to function at the top of their skill set. Who is a better professor of resilience than someone daily tasked with the challenges that accompany physical illness?
At my most skeptical, I can’t help but wonder if we as providers think it a useful practice to employ scare tactics as our first-line method to motivate patients. That somehow, if we abolish the constant stream of fearful statistics from the narrative of their illness, they might actually do worse. And yet, somewhat ironically, we have also come to accept that mental illness and chronic illness go hand-in-hand.
I had the recent pleasure of sitting quietly in an audience of a panel of patients with diabetes, some of whom had lived with their disease for more than fifty years. I was most struck by one panel member in particular: He was an older gentleman who worked as an attorney in an office near Portland. He wore a veteran pin proudly on his blazer. His white beard was trimmed and his posture was straight when he stood to shake my hand at the end of the discussion. He was jovial and swatted away grievances voiced by the other panel members with a hand wave and a smile. He was notable for being the only member on the panel with an amputated leg, a comorbidity most patients with diabetes are taught to live their lives avoiding, even dreading.
“But,” he admitted, “that leg was a damn nuisance anyhow, at least near the end. They don’t take the legs that still work.” He winked.
As a patient with diabetes for nearly fifteen years myself, I found his outlook to be almost scandalous. I have spent much of my experience with diabetes terrified of comorbidities that may or may not arise, and yet here was a man just living his life one day at a time, which in the case of chronic illness is often all I can do. His optimism was — and is — an essential part of my diabetes management. Not at all because it was a cue to lessen the amount of attention I choose to give to my care; only that my care may benefit from elements of self-forgiveness and resilience so that I can pursue health in whatever capacity I am able, come what may.
Many chronically ill patients live full lives, but not without suffering. As responsible physicians, should we continue to teach our patients to fear and mourn their loss of function long before it happens? Perhaps it is a kinder practice to link our patients to other patients: successful individuals who lead rich, happy, fulfilling lives, who have been enriched and deepened by life’s challenges, medical or otherwise.
I think it would be a much kinder practice to introduce our patients to what resilience looks like.
Heather Alva is a medical student. This article originally appeared in The American Resident Project.