Like hikers, patients also need guides

Our family loves to hike. Traveling the trails is a deeply happy place for us. In fact, I don’t think there’s ever been a time when one of us suggested taking a hike, and everyone didn’t unanimously and enthusiastically agree. A few weeks ago, my family took a lovely hike in a state park in Massachusetts. It was a gorgeous day: temperature in the upper 40s, blue skies, no wind. The hub of trails started at a large, beautiful pond. There were large hills in every direction (which we really miss in general since we live in a fairly flat region in the Midwest), and the trails were dry since we hadn’t had rain for a couple days.

We checked out the big map at the trail head and picked up a small folded guide to bring along with us, as there were so many choices and branchings of paths along the way. Both the large wooden and the small paper maps said, as pretty much all maps/guides in any hiking area say, to stay on designated trails both for personal safety and for protection of the land.

We started out along the perimeter of the pond, where most people were walking, and then headed away from the water on a path to see some cliffs. After a short while, we noticed that the path was not well-marked. It was easy enough to follow at the beginning as the cut through the trees was fairly obvious, but as the trees thinned it became more difficult to discern exactly where the trail was. A thick carpet of leaves was everywhere, and since it was early winter there were no ferns or other greenery growing where the trail wasn’t.

All five of us are good with maps and with judging relative distances. The guide we had showed various bodies of water as well as contour lines of changing elevation. With some work, we managed to figure out how to get to each subsequent destination along the trails on our afternoon’s journey in spite of the lack of trail markings. It was a lovely little adventure and a delight to be out in the woods.

But I couldn’t help but think about how disconcerting this could be to someone who wasn’t a seasoned hiker, who wasn’t familiar with topographical maps, and who was travelling alone or with young children. The signs said to say on the trails, but the sign-makers neglected to mark said trails. When you tell someone to stay on a trail, you can’t assume that someone will know where the trail is. You need to provide trail markers.

People frequently use the phrase “blaze a trail” metaphorically to indicate that someone is the first person to do something and that others will follow. However, the actual meaning of “blazing” a path is that someone is providing markers to be used by others to follow that path. It’s not just finding and knowing the way, but helping others find the way as well.

This is the case in medicine. Doctors can’t just tell their patients to do something without explaining in detail the hows, whys, whats, wheres, and whens. A doctor might know what a general piece of advice entails, but a patient could be figuratively lost in the woods without a mark in sight on any tree in any direction.

“Cut down on your sodium intake.” “Take this medication twice a day.” These concepts may be clear and precise to the doctor, but may be vague and unclear to the patient.

Doctors must describe the setting: the situation and what’s happening. They need to describe the different paths, landmarks along the way, and tips for getting through/over/around the difficult parts. They need to describe what to do if their patient wanders off the path: How they can find their way back if they can and how to reach help if they can’t do it themselves.

“Sodium is an element in salt that causes your body to hold onto more water than it needs, and because you have early heart failure it’s important for you to make sure that your body doesn’t have too much fluid. The medications you’re taking help, but your diet is important, too. For the next two weeks, try to prepare all your meals at home — I know you and your wife love to cook together! Don’t add salt to anything. Here’s an example of a nutrition label — see where it says ‘sodium’? Try to make sure that the total amount of sodium on anything packaged that you eat throughout an entire day doesn’t add up to more than 1500 mg. This is hard to do, and it will probably force you to avoid a lot of pre-packaged foods. If you have difficulty with this, I’ll help you set up an appointment with a medical nutritionist. Feel free to call me with any questions, and I’ll see you back here in two weeks.”

Blaze the trail well.

Patients need to make sure they have detailed maps with them, an understanding of how to read those maps, knowledge of what the trail markers look like, hiking partners, and ways to reach help when needed. If their doctors have not been clear and comprehensive, they need to ask for clarity and comprehensiveness.

“When you say to take this medication two times each day, does that mean exactly 12 hours apart? If not, what is the rough window of time that’s OK? Should I take it with food or on an empty stomach? Are there any side effects I should watch for? Do I take the medication all the time, or only when I feel like I need it? Is there anything specific I should or should not do while taking this medication? Should I direct further directions to you or to my pharmacist?”

When people point out that a trail is not well marked, the park rangers will improve the trail blazing.

Maps. Markers. Trails. Skills. Partners. Guides. Communication. Enjoy your hiking!

Abigail Schildcrout is founder, Practical Medical Insights, and blogs at DocThoughts.

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