Seventy percent of the children and adolescents I see in clinic are obese so I have many opportunities throughout my clinic day to talk about exercise and nutrition. Although the general message is the same, precisely how I deliver the information matters more than I could have imagined. I found this out quite accidentally.
It was toward the end of the day, two months after the firestorm in Santa Rosa, California. My clinic was destroyed and I was working out of another clinic site meant for teens, but expanded to serve all ages and conditions. Overnight, the clinic went from having one clinician to three and we were working out of every nook and cranny that little clinic had to offer and seeing every patient, whenever they showed up. All us staff were living in that post-disaster survival state, doing our very best to care for our community while not taking great care of ourselves. That day was no different.
Already running 20 minutes behind, I scanned the next patient’s chart and saw this 8 year old weighed 113 pounds, bringing his BMI above the 99th percentile. I took a slug of water, then trotted off to the exam room. After addressing Mom’s concerns first and getting to know the child a bit, I started my obesity and disease prevention pitch. I hit all the highlights — exercise, avoiding sugary drinks and junk food, increasing veggies, protein and fiber — the usual. But instead of saying “I” recommend 30 minutes of break-a-sweat exercise a day, I said “we” as in all of us in the room — me, Mom and the child needed to get 30 minutes of break-a-sweat exercise a day to maintain our health and prevent disease down the line. I babbled on to say, “this is what I am trying to do for myself each day, and right now to be honest, I’m not being that successful.” My words hung there in the air, and I waited, only now fully aware of what had tumbled out.
In the long pause, I noticed Mom had been fiddling with her purse strap and it wasn’t until she let it go and her shoulders relaxed, I realized just how tense she was about this conversation. Instead of the regular parental nod or the “did you hear that?” directed at the child, the Mom looked me directly in the eye and asked, “exercise is hard for you too?”
And just like that, the door of opportunity for motivational interviewing swung open with a family I had never met before.
We went on to have an honest conversation about why it is hard to make changes, what would make change easier, naturally leading the Mom and the child to voluntarily making their own realistic goal for better health. There is no doubt that this family faces far more barriers to exercise and healthy nutrition than I, but in our common ground of “yeah, sometimes it’s hard to do things even when we know it’s really important for our health,” we had a meaningful conversation that maybe, could lead to a real change in trajectory for this 8-year-old boy. At a minimum, the Mom felt heard and seen in her struggles to provide a healthy life for her son and the child picked his own goal for his health that his Mom could stand behind and support.
Some might argue that a physician’s personal struggles have no place in the exam room. Self-disclosure of any personal information can be deemed unprofessional or detracting from the focus on the patient and their own struggles. Well, that is what I learned in medical school.
But then I thought about my own doctors. Having had breast cancer twice and a couple of chronic diseases as a result of cancer treatment, I’ve seen a lot of doctors in my 39 years. Looking back at all of them, the doctors that I respect the most, and heed the advice of, are the doctors I see as regular humans, not just as doctors. Clinic visits that revealed their humanness, in addition to their intellect, lent them credibility, and quickly. Credibility that no white coat or diploma on the wall or recitation of the evidence could provide. And in fact, doctors that I didn’t view as regular humans with human struggles, I scarcely remembered at all.
Although I don’t always disclose as much as I did in that clinic visit with the 8-year-old boy and his mom, I have been careful to use “we” and “us” when it’s truthful and relevant. I don’t have any long-term outcome data to show this makes a difference. However, I do see an immediate difference in my patient and their family’s faces and the depth of the conversations we have about behavior change. And using “us” and “we” is low tech, free and above all humanizing, not only for our patients, but it’s humanizing for us physicians too. After all, health care is one of the most human of all professions, or at least it can be, when we realize and let our language reflect that we are all in this human endeavor to be well, together.
Jessica Tekla Les is a family physician and can be reached on Twitter @lesjessica.
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