Your Values, Your Healthcare – A Story
About 15 years ago, a woman named Susan came to see me for high cholesterol, pre-diabetes, and high blood pressure, a cluster of symptoms we call metabolic syndrome. She was 53 years old, and found herself more than 40 pounds heavier than she had been at 45. Her work schedule was brutal. It had her skipping meals, eating fast food, and not exercising at all. She was sharp, well educated, and made it abundantly clear that she wasn’t willing to go on the three new medications that her primary care provider had prescribed. Susan told me she wanted a different approach. She didn’t trust pharmaceutical companies, period.
Although I personally don’t feel strongly about avoiding prescription drugs, and certainly don’t mistrust the medical establishment on principle, I understood her perspective. Over the years I’ve seen thousands of patients who feel the same way Susan does. Some have felt the medical system failed them by offering only medication for a symptom, without looking for an underlying cause—birth control pills for irregular periods or antidepressants for fatigue, for example.
You’re More than a Disease
Some felt they were being treated as diseases, not people. Others were frustrated with ten-minute doctor visits, in which they were handed a prescription for one symptom, then came back with new symptoms, only to have the same doctor hand them another prescription for side effects of the first medication. The pattern would then be repeated over and over, sending them down rabbit holes that took years to climb out of.
What they all had in common was a frustration with the medical establishment that led them to me. They wanted, and needed, a new approach. They wanted, and needed, to be treated as individuals, with their own very personal goals, preferences, needs, and values.
After an hour of discussing her health history, current health concerns, how she wants to feel in her body, and her values, I explained to Susan that it was likely we could accomplish most of what she was hoping. It wasn’t going to be easy, but she would need to make some changes, perhaps even cut back her work hours, and make more time for self-care. She agreed.
Because values are so personal, I’m committed to supporting the individual choices my patients make as long as they understand the repercussions of those choices.
Education is Key
If I have a patient, like Susan, who has a symptom or condition that is dangerous or puts her at risk and they flat out refuse medication on principle, I explain the mechanics and risks of the condition and what treatments are available that will actually work. I explain that in many cases there will be a medication that is less harmful than the condition itself, that will work with no side effects at all. I explain that sometimes the not-natural thing may very well be the least harmful thing.
This is exactly what I did with Susan. Her blood pressure was running around 180/120 on a regular basis; this is dangerously high, even in the short term. Then I dropped the bombshell. I asked her to consider a prescription medication, just for the time being, until she made the changes that could lead to a natural drop in her blood pressure.
She was hesitant, of course. But after discussing in detail how the changes I proposed would be treating the cause of the problem, and discussing what exactly those changes were, she weighed the pros and cons for herself. She decided it was the right decision to try the meds. Her health was important to her. Important enough to justify her stepping over the line she had previously drawn in the sand.
I handed her a prescription, and together we discussed a plan that Susan felt was reasonable and manageable.
Are you committed?
Susan was committed. She cut her hours at work, started cooking again, and added in a little bit of exercise. We started her on supplements for her cholesterol and blood sugar and within a few weeks, she started dropping weight. Within about three months, her energy was better, her sleep was better, and her at-home testing showed that both her blood pressure and blood sugar had responded well to the changes. She told me she was feeling better than she had in years.
Then, as I was starting to cut down on the frequency of her check-ins, as well as her medication dose, she started to put weight back on. She was irritable and a bit combative. Her numbers started going back up. I had no idea what had gone awry. We talked and she just dug her heels in and said she didn’t want to continue with the diet changes. She didn’t want to exercise. Yet, she kept coming back. It was obvious she was conflicted.
I spent several visits trying to figure out how to support her. Did she need a gentle push? A kick in the butt? New ideas? I tried it all. Thinking outside the box didn’t help. I was flummoxed. She would agree to a new tactic but each time she came back in her weight was up and she was more and more irritable. She didn’t want to increase her medications to mitigate the damage but she also wasn’t willing to go back to the practices that been working.
Susan was as upset as I was confused. She was clearly and deliberately choosing not to exercise, and clearly and deliberately choosing not to follow the dietary recommendations I made. I kept trying to figure it out. Then one day I stopped. I stopped my pep talks. I stopped looking for reasons she might not be able to follow through with healthy choices. I just stopped. And I listened. And I heard something. I heard her say that she wasn’t sure she wanted to lose weight. Looking back, I suspect that she had tried to say that before but I just hadn’t taken the time to really listen. Understanding this was a turning point not only in her care, but in my practice.
What do you want for yourself?
Then and there, I put my pen down, and took off my glasses. I asked Susan what she wanted for herself. I’d asked this before, but I did it differently this time. This time, I did it with the assumption that not moving forward was the right decision for her at this time, whatever her reason. I asked, then sat back and listened.
She paused, uncharacteristically quiet. Then she said, “my husband likes me like this. He would prefer I were even fatter.” Her husband’s preferences were at odds with Susan’s changing body. To some of you that might sound unreasonable, but for Susan, if her husband loved curves, curves she wanted to have.
Once the underlying truth was out in the open, we were able to have a discussion. We discussed her values again. She had strong personal values both about health and about being a good wife (which for her, at that time, meant pleasing her husband). It was most important for her to feel sexy for her husband. Although she didn’t want to be on medication she understood that she had conflicting desires, and conflicting values. She would have to choose one or the other based on what was most important to her. In the end it turned out that she felt it was more important for her to meet her husband’s physical preference than to lose weight and potentially avoid medication. And although her priorities might change over time, for the moment, this is how they shook out.
Health Decisions Should Be Informed By Your Values
Susan’s story is a great example of the wide range of values that impact health decisions. Some of you will completely ‘get’ where Susan was coming from, and align closely with her emotionally. Others will be appalled that she would choose to meet a certain standard of physical attractiveness for her partner when it clearly had a negative impact on her health. It’s easy to make assumptions about other people’s choices based on our own values.
This is exactly why it is important not only for you to be clear about your own values, but to be able to articulate them to your physician. Your own values need to drive your health care choices. If you don’t know why you’re doing something, your best attempts can short-circuit. If your physician doesn’t understand your motivation and your values, she won’t be able to help you reach the goals you actually want to reach.
What about Susan?
With Susan, we now both had a clear understanding of what was most important to her, enabling me to work with her to craft a new plan for her supplements, exercise, and medication that would keep her healthy even though she wanted to carry more weight. If she wanted to exercise and not lose weight she’d have to eat more. And she could choose to eat healthy foods and still have her body be where she wanted it to be. When I let her direct her own health and healing plan, we both got what we wanted: a healthier body, within safe and practical boundaries. Win-win.
Her values. Her goals. Her choices.
Susan’s case may not be typical but everyone has their own values that drive choices and decisions about health, and about life. It’s imperative to understand what your values are before you make any decisions about what you do and don’t want to do for your health, and what is in alignment with the way you want to approach your health care (and your life.) It is this alignment that allows you to live your very best life, and feel the very best you can.
I want that for each and every one of you from the bottom of my heart.
Yours in Health,
PS. I have a free values exercise for you to download HERE. And remember, you don’t have to do this alone! If you would benefit from having the accountability of an appointment to look at your habits, let’s talk. Visit my virtual consults page to learn more — my favorite part of this? We can work together from anywhere in the world. Hit me up if you have any questions.