Health Maintenance

Today I didn't see one patient who is adequately taking care of themselves. They are not exercising. They are all overweight (or obese). Some of them smoke. There is no health maintenance. Recently I saw a very heavy woman. Her cardiologist told her that she was "Fat and lazy." (He literally used those words.) Today, one of my patients told her that her internist told her to go on a 1200 calorie per day diet.

If every single one of my patients -- EVERY ONE -- that came in today has a problem with health maintenance, how can it possibly be the patients? If one person becomes a suicide bomber, he's insane. But when the entire village becomes suicide bombers, there is a social problem in that village. Clearly, then, there is something wrong in my village. In fact, I think, it's in my country.

Today was a little extreme. Usually I see a few patients who do take care of themselves. But in my practice, it's probably about 5%. That's lower than the national average: about 10% of americans exercise regularly.

It's difficult, because I treat back pain (which is caused largely by obesity) and stroke (caused by obesity) and neuropathy (often caused by diabetes which is caused by obesity). Parkinson's has nothing to do with lifestyle. ALS has nothing to do with lifestyle. Alzheimer's is interesting because there are studies now coming out that exercise seems to decrease the chances of Alzheimer's and that vascular disease has a lot to do with it, so it may partly be related to our lifestyle -- but only partly.

My society is creating too much disease. There is something very wrong with how we're doing things. People aren't being taught how to take care of themselves.

About time

I have fallen terribly behind on writing. There are too many patients to see. There isn't enough time. There is a great problem with this. It cuts into the time for reading and writing. In the academic world, when I was an assistant professor, we didn't really care very much about the quality of SERVICE. We cared about the quality of the care we provided. But SERVICE wasn't an issue. If people had to wait for four or five months to get a new patient appointment, it didn't matter to us. We had the prestige to demand this. Since we taught and did research, we didn't really care that much about patient productivity and our "practice". It was almost a side job. But now, that is entirely different. The patients are the priority. I still find that we don't service people well. We don't get people in here for weeks. It upsets them. The problem is, there just isn't the time. So now, the reading and writing are starting to suffer. Mostly, it's writing. Soon, it will be the reading.

I have thought before about time delusions. We have wrong perceptions of time. The time seems to come and go on its own schedule, rather than our own. We are always making choices about how we use our time. People are always telling me that they don't "have time" to exercise. But we have to make that time happen. We really "have" the time. It's just that we choose to use it doing something other than exercise. It's the difference between letting life happen and making life happen. Letting vs. Making. We just have to create the life that we want.

This is one of the things that is critical to a successful illness. When I have time, I do need to write a book on the good things about illness. (First I have to finish the one about being healthy). I'd better create that time. When we get sick, we tend to re-assess priorities. We make our decisions differently. We change the way that we use our time. I think if I were to get sick, then I would write more. Of course, the practice will suffer a little. People will have to wait, or another solution to seeing people will have to appear.

Focusing

Yesterday, I had an especially "difficult" patient. She was referred here for falling. She wanted to keep on talking about her stress. I usually can listen to patient's concerns. After all, I'm here for the patients. I am here to care for them. But with a referral for a particular problem, it seems that I should address that issue. She has fallen ten times in the past year. This is dangerous. She is elderly, and injury could occur. So I have to figure out why she is falling, and if there is treatment to improve her condition.
Her son had swindled her and her husband out of $100,000 a few years ago. He had stated that she had Alzheimer's, but an evaluation done by one of my colleagues revealed completely normal thinking. Now, he is apparantly trying to take advantage of them again. There are many details, but they aren't really that relevant here. She kept on telling me that she thought the stress she is under is the cause of her falling.
In order to figure things out, I do need some history. So I kept on trying to re-direct the patient; to find out more about this dizziness.
Now, I realize what the problem is. I wasn't really listening.
The problem with listening is remembering to hear what the people don't say. That's the tricky part. She wants this all to be related to the stress. That's because she can't handle anythying ELSE. There CAN'T be anything else. She doesn't have the ability to address another problem. She's here because her doctor sent her here. But in reality, she doesn't care about the falling. She doesn't care that she may fracture her hip. She doesn't care that she might hit her head. She only cares about the problems she's having with her son. So whatever is wrong, it HAS to be related to this stress.
I do think that there are stress related illnesses. I tell lots of my headache patients and my seizure patients about stress. I tell my back pain and neck pain patients about stress. I tell my obese patients about it.
But this balance problem was very clearly physical, and not stress related. So I was trying to explain that to her.
I missed the point entirely. There is nothing that isn't related to this stress for her right now. That's because this is the reality that she has created. So what am I supposed to do about this falling issue?