Blog | Tuesday, May 14, 2013

Your disease, your problem

I get that medicine is hard; I've spent a good portion of my life studying it. Because of this, people come to me for help in maintaining their health. Today's patient tends to have access to much more information than when I started medical school. The Internet gives us all the potential to learn more about our own health.

Unfortunately, there's no quality filter on Google. That's one of the many reasons people come to see me. While I share the ambivalence of many of my colleagues about patients bringing internet printouts to the office, I generally think it's a good thing. It's a great way to open the door to educating my patients. They seem to appreciate my opinions and they feel more a part of their own health care.

Achieving and maintaining good health requires a lot more than googling, though. My biggest challenge every day is treating the Big Three: hypertension, diabetes, and nicotine dependence. These problems require a collaboration between doctor and patient. I can dispense medicines and advice, but I can't make someone change their lifestyle.

These problems are difficult because it's not just about will power. Smoking and eating cause changes in the brain that reward the behavior and punish you when you don't over-indulge. Still, will power is a good starting point.

What I get to see daily is people who come in for a check-up and nothing has changed. They swear they eat "nothing" and yet gain weight; they take all their medications as prescribed but their blood pressure is always high; cigarettes are so expensive that they can't afford the medications to help them quit.

There's a lot doctors and insurance companies can do to help patients along the path to health, including sponsoring weight control programs, gym memberships, and paying for smoking cessation.

But it still comes down to accepting that you have a disease and that managing it is your responsibility. Testing your blood sugar, taking your medicines, watching your eating are all up to you. As a society, we need to be better about supporting these behaviors. We need to make healthy behaviors affordable. If you live in a dangerous neighborhood where it's too dangerous to walk, and you can't afford diabetic supplies, we as a society have failed you.

But it's not just the poor who fail to do their part. All of us have behaviors that are bad for us, and all of us have to take steps to make ourselves better. Come by the office and ask me where to start.

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog at Forbes. His blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.