Sunday, April 1, 2012

Behavior Change

“I am a physician, and as such, I demand that you alter your behavior.”
Lvov in Anton Chekhov’s Ivanov, Act 3

I love this quote because it exemplifies the opposite of how I believe physicians should go about changing patients’ behavior.  In Chekov’s play Ivanov, Dr. Lvov is highly critical of Ivanov’s treatment of his wife Anna (who is dying of tuberculosis) and skeptical of his intentions toward Sasha (and her dowry).  As you might imagine, ordering Ivanov to change is not particularly helpful and several people end up dead before the play concludes.

As a physician, I am invested with a certain authority to give people advice.  When I do, it is not simply my personal opinion but based on a body of scientific literature and the outcomes of other similar patients.  I tell you to quit smoking (for example) because I know the data on increased mortality.  In addition, I have seen people die of lung cancer, esophageal cancer, heart attacks, strokes, COPD, blood clots, and other preventable smoking-related causes.  And I have seen people suffer from chronic lung and blood vessel damage for years before they die.  It’s not pretty, and I want to spare you from a similar fate, if possible.

However, demanding that you quit because I say so is not likely to work.  I also have data and experience to draw from in the realm of facilitating behavior change, favoring more patient-centered counseling styles.  The key is to help you help yourself, by exploring your point of view and working with it. 

If your goal is to breathe well enough to keep up with your kids, we can aim for that.  Or if your goal is to stop wasting money on cigarettes, we can aim for that.  You know what is important to you.  You also know the challenges you are going to face: the smoking co-workers, the morning cup of coffee, driving, or whatever your personal temptations are.  We can treat the chemical side of addiction, but also need to think about the patterns of your life.

Whenever you make a change, you have to find the way that is going to work for you.  Everyone has unique barriers and strengths that have to be taken into account.  You know yourself better than anyone else.  I can point you in the right direction, but the motivation has to come from you.  In the end, it is not about me (or Dr. Lvov). 

Chekhov: the Major Plays, translation: Ann Dunnigan
Signet Classic: Penguin Books, USA Inc, New York, 1964.

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