What can and can't be changed

I am a skeptic by nature. More often than not, however, skepticism has to be suspended to take good care of patients. Many is the time that a person has sworn up and down that they are ready to take the next step in behavioral change. For example, I am not a haranguer, but no matter how subtle I try to be, it's rare for a patient not to pick up the very clear message that they should quit smoking. People have heard often enough that they should do so.

They come to my office with a natural instinct, to make me happy, and thus they tell me they are going to quit. Or if they aren't really ready, they feel bad about saying it right out, so they don't come to that statement right away but save it for later. If they tell me they are going to quit, though, I am duty bound by something older than the Hippocratic oath to say, "Yes, you can!" and support them. In other words, I must put aside my skepticism for a moment and believe in the possibility of change.

Then, of course, I realize time and again that I make mistakes in my practice. Despite the ever-present excuse of inertia, I need to believe that I can get better, as well as the system I am a part of.

Believing in the possibility of my change can reinforce my optimism that my patients can change their own lives for the better, with my help.

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.