Last year, my high school aged son took an interest in healthy eating. He began examining nutrition labels and scrutinizing the foods that we routinely keep around the house and came up with a list of criticisms and suggestions — some well-founded, and others a bit extreme. At first, my wife and I were quick to debate him on certain choices like eliminating any breakfast cereal that has enough sugar not to taste like cardboard, but our eating chasm just widened, our advice was ignored, and he became more resolute in his views. Once we showed genuine interest in and openness to his ideas, he relaxed a bit, and we began to enjoy our family meals together much more. And we did not have to agree with him in order to relate more effectively.
I thought about this today shortly after my visit with Mrs. K, who I was seeing for malaise and fatigue. After we reviewed her normal blood tests and conversed for a few minutes about depression, she told me that she was planning to try B-complex and magnesium, a combination that a friend of hers had suggested. I am admittedly not a fan of alternative supplements like these when taken for issues for which they have no scientific credibility. But, as with my son, I have found that taking a hard line on this with patients is unhelpful, and sometimes alienating.
Parenthood and patient care certainly contrast in more ways than they have in common, but areas of wisdom can still overlap. In this case, it all comes down to humility: acknowledging that we don’t know everything, and showing openness to new discoveries. In both realms, this seems to improve relationships. Many patients, especially those with severe or life-threatening illnesses, have a strong yearning for some semblance of control over their lives, and if any extra vitamin or herbal product helps them achieve this positive mindset, then why should I thwart that? By delegitimizing alternative treatments, we sometimes end up only undermining our patients and ourselves, and perhaps lessening adherence to important prescribed regimens. It is no wonder that the nutritional supplement industry is booming, and many of those who proudly declare, “I’m not a medicine person” are taking handfuls of them every day.
In many cases, good doctoring is about being a guide, rather than an authoritarian.
Adherence begins with patients feeling heard, which requires listening without judgment. Like with our families, good relationships are what keeps them coming back.
Jeffrey H. Millstein is an internal medicine physician.
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