Gary McClain, PhD, is a licensed counselor, research consultant, speaker, and author who specializes in the emotional impact of chronic and catastrophic illnesses. In this series, he provides guides for how to tackle communication challenges with your doctor.
Mike has recently been diagnosed with a chronic medical condition. His physician explained to him that, in addition to medication, Mike will need to make extensive lifestyle changes, including modifying his activity level and adopting a new diet. Looking back on that conversation, Mike remembers that an alarm when off in his mind when his doctor said the words: “This should be easy.”
Later that day, while reviewing the pamphlet about his condition he had been given, Mike agreed that, yes, the plan should indeed be easy. And probably was easy. For someone. But not for him.
"Easy? Not for me."
Have you had the same experience as Mike?
Physicians have the best of intentions when they recommend lifestyle changes to individuals facing a medical diagnosis. But their suggestions might not be attainable for you.
Maybe it's an exercise routine that doesn’t fit with the way you want to exercise or that doesn’t fit with your budget. Or maybe it's a diet that doesn’t include any of the foods you are used to eating, or introduces foods you already know you don’t like or that will be difficult or expensive for you to prepare. They want you to make changes in your daily routine that, unless you are living alone, just aren’t going to be realistic for the others in your household. Or maybe, now that you’ve reviewed the list, the recommendations just aren’t all that clear ("I’m supposed to be eating what?").
As a result, like Mike, you may be reviewing your doctor’s recommendations and, instead of nodding in agreement like you did in his or her office, now you’re shaking your head in disbelief and asking yourself, “What did I agree to?” On one hand, you know that change is necessary to take the best possible care of yourself. On the other hand, you may not see how you can accomplish this with the recommendations your doctor gave you.
Treatment plans: a collaborative effort
Your treatment plan should be a collaborative effort between you and your physician. Here’s how to get the collaboration started:
1. Don’t assume that there is only one way to live with your condition. If you view the plan you have been given as the only approach to maintaining your self-care, then you may feel like giving up before you get started. Instead, think of these recommendations as getting the conversation started—an ideal approach, but not the only approach. Your self-care plan is a work in progress, and will most likely evolve over time.
2. Don’t assume that your doctor’s attitude is “my way or the highway.” Physicians are busy, and they don’t always have time to tailor a lifestyle management plan for each individual patient. Partnering with your doctor means asking questions and having discussions about your treatment and self-care, so that as your doctor better understands your wants and needs, the plan can become more tailored to what will best work for you.
3. Ask yourself what is making you uncomfortable. Reading through a list of guidelines can be scary, especially the first time you go through them. To help get past the initial shock, go through them one by one. And for each recommendation, ask yourself: What would be involved in following this recommendation? What’s hard about it? How would it benefit me? Is it possible that I could make it work?
This exercise may not give you all the answers, but at least you will come out of it with a better sense of which ones are immediately doable, and which ones present challenges.
4. Take an honest look at your own willingness to make changes. If there is one thing human beings often avoid, it is change. We like our familiar routines and habits—even if some of them aren’t so good for us. So as you evaluate your doctor’s recommendations, ask yourself: “What’s bothering me here? The plan itself or the changes that I would have to make in my familiar routine?”
5. Do some of your own research. The Internet is rich with medical information, including recommendations for condition-specific, self-care. Do some research on alternatives to your physician’s recommended plan. See what you can come up with that might meet the same goals. Print them to take to your next appointment.
6. Ask to meet again and discuss the plan. After you’ve thought about the recommendations your doctor has made, done your research on the alternatives and even tried to follow the ones that you could follow, schedule another appointment.
7. Come prepared. Keep in mind your doctor most likely doesn’t have a lot of time. So be prepared to briefly present your concerns, your key questions, and your proposed solutions.
8. Start the conversation on a positive note. Physicians are often confronted by patients who are argumentative, refuse to be compliant, or are hoping if they whine long enough and loudly enough, they can talk their doctors out of having to make any changes in their comfortable—but damaging—routines. Who knows, the patient before you may have fit into one of those categories. Be clear about your goals, beginning with the overall goal of wanting to team up with your doctor to support him or her in treating your condition.
9. Be ready to negotiate. Your self-care plan is a work in progress. Ask your doctor about what aspects of the plan can be “swapped out." For example, alternative ways to get exercise or a diet that you can more easily follow. It may be possible to gradually phase in some of the changes that are most disruptive to your current routine. Let your doctor know you’re willing to be flexible, but you also need him or her to be flexible as well.
Get the treatment plan that works for you
Here’s what Mike did: He went through his doctor’s list of recommendations and picked out the ones that he either knew weren’t realistic or that he didn’t understand. He went to a trusted website and found alternatives that would be a better fit. He made a list of questions. He provided his doctor with a plan that he could commit to. They ironed out a new plan.
Remember it’s about teamwork, not about being right. Optimal lifestyle management doesn’t have to be a power struggle between you and your doctor. In fact, most physicians welcome the opportunity to collaborate with their patients on the best way for them to stay compliant on the treatment journey, and they recognize that patients have preferences and limitations that will require some fine-tuning along the way.
The success of your treatment plan is your hands. Team up with your doctor and create a self-care plan that you can—and will—follow.