How to spark the attention of patients

I’ve been mean to my body lately. And since I know better, I talk negatively to myself about why I continue to be mean to my body. Lately, I’ve been considering why I do this — why we do this — and how to think about ourselves differently.

Several months ago I had immobilizing low back pain. I broke my low back in high school, and this pain was similar. After X-rays came back negative, the most practical thing to do would be rest and find conservative physical therapy to ease symptoms, but I didn’t do that. I ignored it, took painkillers, and started training for a half marathon.

Several weeks ago, I acquired knee pain that halted my ability to run. I ignored this one too, but ended up limping so severely during a 6-mile run that I was forced to stop, eyes tearing due to frustration. The most logical thing to do would be see a professional, rest, and be gentle until I figure out what’s going on. But I haven’t done that.

What I would recommend to someone in my situation is not what I do for myself. I think this narrative is familiar for many of us.

It’s an illustration of the battle between the logical, conscious brain (the one we think is the decision-maker) and the unconscious, emotional brain (the one we think we have control over). The author Jonathan Haidt likens this to a rider on an elephant. The rider (our conscious) believes she is in control when truly, she has negligent influence on what the elephant (our unconscious) wants to do or where it goes. What the rider does, then, is notice where the elephant goes then subsequently rationalizes those behaviors.

Earlier I said I talk negatively to myself. But who is “I” and who is “myself?” I am my conscious brain. Myself is my unconscious brain. It is clear that “myself” is in control. It is an elephant.

How do we make the rider and elephant work better together? One way is to identify the dynamic. We should understand our values and emotions are far stronger than logic in determining behavior, and we should appeal to the elephant rather than trying to control it. A dynamic of noticing, listening, accepting, being curious about, and coaxing new behaviors from the elephant gives the rider a positive, non-zero influence on where the two might go. A dynamic of coercion, anger, frustration, and judgment from the rider guarantees a total loss of power.

As a medical student, I think about this with regards to future patients. We love data and statistics as a medical science community. A physician I was once observing told a patient something like: “If you increase your exercise to 30 minutes 3 times per week, you have a 50 percent chance of reducing complications from heart disease by the time you are 65.” (I am sure my numbers are wrong, but the sentence was structured in this way. In fact, my inability to remember the numbers is diagnostic of the problem I want to convey.)

I would bet $10 the patient forgot that information and did not implement behavioral modifications. Appealing to the logical rider is the incorrect target. In order to implement behavioral changes, we have to spark the attention of the elephant. We should consider values and goals, disposition and relationships. We should consider what emotional drivers would make an unconscious mind goal-oriented about changing directions. As health care professionals, our role is to translate objective data into subjective experience.

And importantly, recognizing how to do this for others, we should learn to do this for ourselves.

Jamie Katuna is a medical student.  She can be reached at her self-titled site, Jamie Katuna, and on Facebook.

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