'Rx: The Quiet Revolution': It All Starts with Mindset

Editor's Note:David J. Norris, an anesthesiologist, as well as a member of the Physicians Practice Physician Advisory Board, offers her review of the recent PBS documentary "Rx: The Quiet Revolution."

As the film started, I was dreading another discussion about cold, impersonal doctors who need to change. I was prepared for some doctor bashing. However, I took away something completely different and found the film quite enjoyable.

As physicians, we actually have very little power or influence of the state of our patients' health. Ultimately, their health, or lack thereof, is completely in their own control. The patient dictates to themselves what they will and will not do to achieve health. We simply provide them the opportunity to learn about their diseases and therapies that can improve their lives. Healthcare with a human touch would appear to be about listening, empowering, and coaching the patient to better health.

Early in the film, I was sympathetic to the discussion of the physician owning responsibility for someone else's health. We want to help others so badly sometimes we decide we should carry their burden. In doing so, physicians can forget that our patients have a free will to think and feel. They can choose to be healthy with their actions and behaviors. What is needed is the human touch through listening, affirming, and working with the patient to change their personal views and expectations of their chronic diseases.

Health, quite simply, is a state of mind. The physician must help the patient see how their current mindset affects their health. Patients might not understand how their mindset affects their choices that ultimately affect their health.

Mindset vs. Attitude

If you look up the word mindset you will find it defined as "a person's attitude or set of opinions about something." If you look up attitude, it's "the way you think and feel about someone or something." So a mindset is how someone thinks and feels about something. This is a very important starting point. Why? Because every action we take and every decision we make begins with mindset. Our thoughts and feelings always dictate our actions and behaviors. We think and feel first, and then we act. If we think we can't do something, we won't. However, if we think we can, we might.

Ultimately, good healthcare is really about the patient's behavior. Physicians, especially in primary care, are tasked with getting people to change their behavior in a manner that is beneficial to their chronic disease. Diabetics should monitor the blood glucose levels, exercise, and eat right. Those with coronary disease need to alter their diet and work at reducing their cholesterol levels. The physician might actually be more of a coach for the patient. Someone who sets the goal, monitors progress, offers advice for improvement and keeps them focused.

But it all starts with mindset. How do we get someone to change their mindset? Change their thoughts and feelings about themselves? How do you encourage someone who is overweight? How do they overcome those self-defeating thoughts? That's the challenge for the future of healthcare.

How does Dr. David Loxterkamp in Maine get the obese patient sitting in the hot seat to change her diet? She says losing weight is hard and she is correct. However, the underlying belief she holds is that it is impossible, so why try? Dr. Smith encourages her to eat green foods and walk a little. He doesn't say "lose 50 pounds this year." But rather, he is focused on trying to get her to change her behaviors. However, for that to occur her feelings and thoughts must be changed first. It can be done. It is possible.

From Confidence to Ownership
I particularly enjoyed the portion about On Lok in San Francisco. This is an example of people who had a mindset that says, "I'm in control. I will not go into a nursing home. I need help, but I'm taking responsibility and the risk." With that mindset, this organization has seen great results. Why? Because everyone in the organization has the proper mindset. The Alaskan healthcare system is another great example. They are using some really great technology to deliver care, but it really is augmented by the mindset of the patient-owners. They have changed their mindset over the years. They used to accept the old model, but decided to think through the process, and then acted to change their behaviors. First, they changed their thinking and feeling and the rest followed.

As one of the physicians said, "self-confidence is key to success, living well, and being well." If physicians are able to help patients understand the chronic diseases, equip them with the power and tools to manage those diseases, then the patients will begin to feel confident. It begins with a physician who can listen. If we rearrange the letters we get the word silent. If we rearrange the letters again, we get enlist. The basis of the human touch in healthcare is listen, be silent and learn what we can do to enlist the patient's efforts in changing their mindset and give them confidence.

From confidence comes ownership. Ownership then yields responsibility and accountability. Without the last two, patients will never get better or improve their health and general well being. The human touch of healthcare is why we went to medical school. Now it is up to us to listen and help the patient help themselves - change their mindset.