Your health – your problem and your duty

A favorite patient of mine recently asked me what I was going to do about his weight problem. I thought of offering to tape his lips together, but instead just reminded him that his health was his problem, not mine. His look in response seemed to suggest he thought that was a crock; if I could not solve his health problems then what the heck was I being paid for?

The encounter reminded me of a warning given to me by a family physician who has long been one of my mentors; “When you are working harder on the patient’s health than the patient, there is something wrong with both the patient and the doctor.” I thought that was a crock at the time; the idea ran contrary to my belief that with a brain smart enough and a coat white enough I could save the world from itself, in spite of itself, one patient at a time. Patients just needed to trust me and do what I told them and all would be well.

Unfortunately, I turned out to be less smart than I thought, the world has proved a tad resistant to my efforts to save it, and the longer I work as a physician the more I think my mentor was right. In fact, as a doctor I now think that as a patient your health is your problem, not mine. I’m here to help you with it, but it’s your high cholesterol, your diabetes, your emphysema, your depression, your work to be done. In the patient-physician partnership, the doctor is the plow but the patient is the truck. The doctor is the bullet, but the patient is the gun. The doctor is the makeup, but the patient is the prom queen. Get the picture?

Without the patient’s initiative and energy, the team is going nowhere, not to plow the road of chronic disease, not to shoot the killer cancer with the bullet of prevention, not to the prom of healthy aging, not anywhere. In fact, without that energy, patients might as well just come to doctor’s office, give cash to the receptionist, and leave. Doctors can then just cancel office hours and tour the French countryside while sipping wine.

The idea that the patient is ultimately responsible for his or her own physical well-being and health care may seem obvious, but most of us behave as though we think otherwise. Too many of us drive our lifestyles much the same way we drive our cars; heavy on the pedal, fast around the corners, and skimpy on the preventive maintenance. Then, when a piece of the our body’s transmission falls out on the road, we limp into the doctor’s garage and say, “Hey, Doc, can you check under the hood, fix whatever ails me, and get me right back on the highway?” We tend to treat our health problems as our doctor’s problem to fix for us, and not as our own.

That model for the roles in the doctor-patient relationship was once appealing to both patients and doctors. It absolved patients of the responsibility of taking care of themselves, and it cast doctors in the role of decision-makers and miracle workers. Patients got absolution, and doctors got worshipped, and my white coat almost glowed in the dark. That it was largely a crock that often did not work did not really matter.

It matters now, however. The health care partnership with the doctor as the mechanic and the patient’s personal health as a car to be driven into the ground and then repaired to pristine condition is a failure of growing importance. It fails to prevent preventable disease. It allows patients to age and die poorly, prematurely, and expensively. Most importantly for our nation, it costs too much because it is based on the costly model of disease treatment instead of disease prevention. It is Humpty Dumpty health care, where the patient hopes the medical profession’s horses and the medical professions’ men and women can put Humpty back together again. The new model; sorry Humpty, quit playing on the damn wall because we don’t have billions to spend when you fall off.

If we are to live well as we age and to have affordable medical care, the patient must drive his or her personal lifestyle of wellness as if our nation’s economy and health care system depend on it, because they do. (So does our health, but let’s talk about what really counts – money.) We need every dollar that buckling every seatbelt can save. We need to get every flu shot that should be gotten, so we can prevent the wasting of millions of health care dollars on influenza. We need to shed every extra pound of fat, and leave every costly case of preventable diabetes by the side of the exercise trail. We need to stop wasting billions of dollars on diseases caused by cigarette smoking. We need every penny that can be saved, and we all need to shoulder some responsibility for saving them.

We live in a country where many support, and profit from, our unhealthy lifestyles. In the end, however, we remain principally responsible for our own ill health. We can no longer afford to act otherwise, because we can no longer afford a model of health care in which the patient drives the car of personal health into the ditch and thereby the cost of health care through the roof. If America’s Uncle Sam donned a white coat and stethoscope he would point out from the poster at us and say, “I need you – to be healthy.” Maintaining the best possible health is no longer just the patient’s job, but a personal duty and a national necessity.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.