Helping Patients Manage Illness-Life Balance

Last week I wrote about a conference I attended and a couple of the lecturesthat were particularly meaningful. The second lecture was from a patient who has battled a vast and extensive array of medical conditions. As a young, single mom, she developed severe cardiorespiratory disease and continues to fight along each step of this journey. Her talk was inspiring and humbling, reminding me of the very small snapshot we as physicians have into our patients’ lives. 

In listening to her experiences, which are unfortunately ongoing for her, I consider the concept of illness-life balance. How do our patients manage that? I see my patients on a continuum of health and disease. I ask about their families and their lives but feel my first obligation is to their disease process or preventive health, not to their personhood. That’s hard to write - I wish it weren’t true, but it is. I believe myself to be a humanistic doctor, but I’m much more of a doctor than a humanist. 

I wonder how it would look to enter my patients’ lives and help them with their disease-life balance.  Would I take their complaints about medication side effects more seriously? How meaningful is the lipid-lowering property of a statin if you can’t remember where you put your car keys or what you were supposed to do this morning? Is it really more important to have blood pressure at goal than to be able to make love to your wife? My perspective is so narrow. 

I wonder what my patients would think if I asked more questions about how they are managing with their diabetes than asking about how they are managing their diabetes? What if I asked about what is important to them and made it my goal to get them as much of whatever that is for as long as possible?  What if I (gasp) abandoned clinical practice guidelines and instead truly used a combination of intelligence, common sense, insight, and conversation to make a treatment decision with my patient?

I’m not quite ready to completely redesign how I practice medicine. Old habits die hard and I was trained, after all, to cure disease and to move on when I can’t. I not only would have to learn a new way of relating to patients but unlearn the disease-centric way of thinking that our medical establishment currently embraces.

So, I’m going to start small. I’m going to find out about how my patients live. Not just what they weigh, what surgeries they’ve had, and whether they smoke. I’m going to find out and emphasize what’s important to them. I’m going to try to lose my disease-oriented mindset and become patient-oriented. I’m going to start by asking many more questions when patients come in for their annual exam. I’m hoping this conversation will serve as a better basis to discuss their health and illness and disease and life.