Category Archives: Making Change

My Secret

I have a secret that I want to share with you, but you have to promise to not tell anyone.  Do you promise? If the answer is “No,” stop reading now.

Before I reveal my secret, I want to tell you a little bit about my wife, Julie.  When I met Julie, she was an avid runner, and that habit continued throughout most of our marriage.  You may have noticed that I used the word “habit” rather than “hobby.” My choice of words was not random.  A habit implies a repeated behavior incorporated into one’s psyche, where a hobby is a pleasurable leisure activity.

Julie loved to run. Running gave her energy and made her feel emotionally happy. Several years ago, she had a knee surgery that resulted in a bad outcome. That ended her running career.  This was devastating to her, and she grieves the loss to this very day. To understand why that is the case, you need to learn just a little about how the brain works. 

A structure in Julie’s brain, the nucleus accumbens (NA), becomes more active when she runs. The NA is part of the brain’s reward pathway.  This is a pathway that is activated to reinforce behaviors that are necessary for species survival. Have you ever eaten a great meal and had a sense of ease and contentment afterward?  When someone gives you a genuine hug, does it feel wonderful? Do you feel happy and mellow after a positive sexual experience? What you are feeling is an activation of the reward pathway; all of these activities are directly or indirectly necessary for our species’ survival. 

There are ways to corrupt this pathway.  Drugs of addiction, including cocaine, heroin, and alcohol, abnormally activate the reward pathway.  Process addictions, like shopping and gambling, also activate this connection.  The reward pathway doesn’t have logic; it is reflexive. When a drug like cocaine activates it, the brain assumes that cocaine is necessary for survival. Your brain seeks out cocaine, and an addiction is born. 

The reward pathway’s sensitivity is governed by several factors, including a person’s genes, and different brains are likely activated by different things.  Alcohol may over-activate one person’s brain but not others. Likewise, exercise may be triggering for one individual but not so much for someone else.

Why would one person’s NA be highly sensitive to exercise when another person is not? Is physical exercise necessary for species survival?  As a species, we need physically active members.  However, exercise is less important than eating or procreation.  If you have more active and less active individuals, your overall species survival may be enhanced.  Individuals who like to exercise could become warriors and builders.  Those who prefer a more sedentary lifestyle would be content serving in other important but less physically demanding roles. 

Our automated lifestyles are very recent in our evolution; everyone had to exercise to some degree in the past.  However, over the last decades, the physical demands of humans in developed countries have diminished exponentially.  We can order our groceries online, drive to our appointments, and even use a “robot” to vacuum our carpets. Our increasingly sedentary lives have had increased health consequences ranging from obesity to dementia. Since we don’t have to toil in the fields, some go for a run or spend time at the gym.  For someone like my wife, it is easy to adopt an exercise program. Why? Because she has  direct emotional and physical benefits from exercising.  Who doesn’t like doing things that feel good?

Here is my secret, I don’t feel good when I exercise.  In fact, I feel sort of lousy when I do it.  I used to feel guilty that I hated exercise.  I thought that there was something wrong with me or that I was just plain lazy.  However, I now know that my brain just operates differently than some. Yet, I know that it is essential for me to be physically active.  How does someone like me exercise regularly?  How do I turn a negative into a positive? 

When I married Julie, I was carried away by her exercise enthusiasm. I outfitted my basement with thousands of dollars of gym equipment.  Every day I would force myself to go into the cellar and exercise.  Every day I hated it. Despite my feelings, I exercised for over a year until I had a minor injury.  I then stopped altogether.

Many years ago, my friend Tom encouraged me to join his gym.  I would meet him at 5 AM most days before I worked with my personal trainer.  Afterward, we would have coffee. I looked forward to going to the gym and reaped the benefits of all of my physical activity.  After some time, Tom’s schedule changed, and he stopped coming.  By then, I had established myself with some of the other gym rats who welcomed me into their fold.  However, I found myself getting bored, and soon I came up with reasons to sleep in. The new reward didn’t offset the pain. 

I knew that I had to do something physically, so I came up with another plan. I would get up very early and walk to my local Starbucks-a round trip of 3.5 to 4.5 miles, depending on my chosen route. I do enjoy walking, thinking, and meditating. At Starbucks, I formed friendships with some of the customers and had good relationships with the baristas.  As a bonus, Tom would visit me on occasion.  However, the real draw was that I used my time at the Starbucks to write, and I even had a dedicated table at the coffee shop. I was motivated to walk every day and did it one day when it was -27F outside.  Unfortunately, all of that ended with the onset of the pandemic.

Walking and hiking are my favorite exercises, as they have many sensory dimensions.  Movement for the sake of activity doesn’t do it for me.  Exploring nature is motivating, but unless the scenery is incredibly engaging, it is still insufficient to get me out of bed every morning. I have found that I must combine my walking with another activity.  Tom bought a townhome closer to my home, and I’m motivated to walk there to visit with him.  My kids like to walk, and it is enjoyable for me to walk and talk with them.  I also like to walk somewhere with a purpose.  For instance, I don’t mind walking to our local market to pick up a few groceries.  I have found that combining exercise with something that I enjoy reinforces my desire to be active.

I have also come to realize that some exercise is better than no exercise. In a perfect world, I would do various exercises that increased many aspects of my physical well being.  However, I don’t live in an ideal world.  Instead of constantly feeling guilty that I’m not doing enough, I am committed to celebrating what I am doing.  Such an attitude promotes the continuation of a behavior.  Guilt often has the opposite effect.

If I can pair a positive with something that I don’t want to do, it is much easier for me to accomplish my goal.  This has been the case with exercising regularly, and I also do this “combining” technique for many other things that range from making dinner for my family to paying bills.

I pass this idea to you.  Are there things that you need to do in your life that you procrastinate around?  Consider pairing them with something that you do like, and you will probably have more success in accomplishing your goals.

Peace

Mike

I like to walk in nature. I can enter a walking path very close to my home.
Trees give me a feeling of comfort.
This path abuts a river.
Walking with a practical goal motivates me. Here I walked to my local market to buy a few things for dinner.
It is important to plan ahead. A shoulder bag makes the return trip home easy-hauling a number of plastic bags would be a drag.
I love looking at scenery when I walk. Here I’m spying some graffiti on a viaduct.
I love walking with my kids.
Here I’m walking by our carillon. It serenades our downtown on the hour.
The only exercise equipment that I need is a decent pair of shoes.

The Cabinet Under The Sink

“Dad, it’s dripping.” I looked towards the sink and witnessed a single drop of water form and fall from the kitchen faucet. “Maybe the handle isn’t all the way off,” I commented.  I went to the sink and tapped both the hot and cold handles.  They were already closed, but I was hopeful. A minute later, another drop was perched and ready to dive.

Our faucet had been replaced 10 years earlier when we did a partial remodel of the kitchen.  I had long forgotten the faucet brand, or even where I purchased it.  Also, I had no idea how to fix a leaky faucet, although cloudy images of washers and O-rings danced in my head.  It was time to visit YouTube.

I quickly found several fix-it posts. Like most DIY videos, the process looked simple enough. “I can handle this,” I thought. Those of you who are regular readers of this blog may be thinking, “Why not call your contractor friend, Tom?” Dear reader, I am privileged to have a talented friend, but I don’t want to abuse his goodwill.  Besides, I was already encouraged by my recent dishwasher repair.  But as George Bernard Shaw said, “Beware of false knowledge, it is more dangerous than ignorance.”

Armed with a Phillips screwdriver and a pair of channel locks, I faced my foe.  With a MacBook by my side, I played the first segment of the video. “Make sure that you turn off the water valves under the sink.” That sounded like a reasonable step.  I reached into the chaotic mess in the cabinet below and blindly felt for the rough metal oval that functioned as the shutoff valve.  Grunt!  Grunt, grunt, swear… more swears….more grunts. The valve was frozen.  Defeated within 5 minutes of starting!  With my head hanging low, I pressed the FaceTime icon on my iPhone and then hit the button labeled “Gizmo” for my friend Tom. He answered, and I asked in earnest seriousness, “How can I close a frozen water valve?  Can I hit it with a hammer or something?” “No, don’t do that; you could have a flooding disaster! Hold on, I’m coming over,” Tom replied.

Ten minutes later, Tom was at my front door, his toolbox at the ready.  He reached under the sink and found the offending water valve.  Tom was able to close the valve without difficulty.  Dear reader, you have to understand that my hands have only had to grip objects like pens. My digital muscular strength was developed to accurately hit the keys on a computer.  Tom has a definite advantage as his mitts frequently turn wrenches, carry heavy objects, and twist bolts.  I can only feel so ashamed about my inferior gripping and twisting ability. 

With water off, it was time to remove the faucet’s handle and replace the defective water flow cartridge.  This involved releasing a special retaining nut.  The nut was where my problems escalated.  The thin metal was calcified by being subjected to years of Chicago’s hard water. When we tried to loosen it, the nut disintegrated.  …more swearing ensued.  

The planned obsolescence reality is that it is easy to buy a replacement faucet cartridge, but it is impossible to purchase its companion retaining nut.  This latter fact was confirmed after visiting three different hardware stores and talking to two “plumbing experts.” My only option was to buy and install an entirely new faucet.  Now I really needed Tom’s expertise.

I also had to tackle the mess in the space below the sink, and that cabinet is the central metaphor for today’s post.  I apologize for my long preamble, but I needed to provide you with some context for today’s story.

The region under my kitchen sink has long been the equivalent of a junk drawer.  A place where nearly empty bottles of cleaning chemicals live.  A zone that collects never to reuse grocery bags.  A region of specialty cleaners that I buy but then forget that I have.  Four different granite cleaners and at least three different types of glass cooktop polishes were only two of many categories found.

The cabinet was bursting and chaotic because of its massive overflow.  I found two brand new buckets of dishwasher packets even though I thought we were completely out.  Three different glass cleaners were also located. There were enough unused sponges that, if “real,” they could have repopulated a small coral reef.  

Confusion ruled. Empty products had equal status with unopened new containers.  The space was so disorganized that it was easier to buy a new bottle of something rather than to look and see if one already existed.

The first category to be tossed was my massive collection of useless plastic grocery bags. I then categorized the other items.  One pile became a mountain of sponges, another zone had powdered cleaners; still, another region was designated for granite products.  Nearly empty items were discarded, as were those that had broken sprayers or cracked caps.  I then organized the groups into plastic bins.  

With a small amount of effort, years of disorder were transformed into a neatly organized and functional space. My life had instantly become simpler by applying a little time to the problem. Why did I wait so long? 

In many ways, the lazy behavior that I exhibited was no different than other actions that have hampered me in my life.  It was simpler to go with business as usual than to take a little time and change a bad habit.  It was easier to maintain broken relationships than to admit that it was time to move on. Having to deal with life’s clutter made it impossible to enact simple solutions to make beneficial changes.

Just like cleaning my “junk” cabinet makes sense, it also makes sense to evaluate my life’s situations regularly.  What should I keep?  What should I get rid of? What should I reprioritize?  Items that entered my cabinet with the promise of making a task simpler often just made things more complicated, and it made sense to recognize their false promise and rid myself of them.  The same can be said of my life; some situations that promised benefit actually delivered the opposite.  It is my personal responsibility to make sure that my life is uncluttered so I can see the forest for the trees.

Once I had emptied out the cabinet, it was simple for Tom to replace the errant faucet.  Another lesson can be learned here.  I probably could have completed the repair myself, but it would have taken me much longer, and the outcome may have been worse. Yes, you need to solve your own problems, but sometimes it makes sense to call on an expert to assist you.  Their knowledge can turn a difficult job into a simple task.

Do you need to clean your metaphorical cabinet?

Peace

Mike    

With a small amount of effort disorder became order.
Sometimes it makes sense to call on an expert.
No more drips!

Three Real Ways To Change A Dysfunctional Behavior

One of the most challenging things that we humans do is to change dysfunctional behavior. Yet, it’s something that successful people must accomplish regularly. If you want to move forward, it is imperative to recognize problems in your life, address them, and fix them.

I believe that most of us know this, but many contemplate the need to change without ever acting on making a change. Others force themselves onto a radical path of change, and like a flash fire, they burn brightly, and then they flame out. An example of this is the classic New Year’s exercise resolution, “I need to exercise more.” Drive by any gym during the first week of January, and you see that the parking lot is bursting at its seams. If you want to get a good parking spot, just wait a few weeks for the resolutioners to fall back on their old behaviors.

As a therapist, I often saw patients who claimed that they wanted to change. In some instances, what they wanted was for other people to adapt to them so they could continue their dysfunctional actions. They wanted the world to change for them (good luck to that). However, I also treated individuals who sincerely wanted to take responsibility for their lives and were willing to put forth the effort to make change. It was then my job to teach them the tools to accomplish their goals. Naturally, there are many ways to elicit change so that I would customize my approach based on the person’s needs, personality, and behavioral style.  

Today I would like to share with three “generic” change approaches that you might consider. I’m going to do this by citing some examples from my own life.  

Method 1

Pairing a new behavior with things that you enjoy.

I hated exercise. When I was morbidly overweight, I sought the help of a weight-loss specialist. She was a thin wisp of a young girl who appeared to be very physically fit. I wondered if she could relate to me and understand the plight of an old fat man. 

She did some quick calculations of my weight and BMI and then scribbled a few numbers onto a pad of paper. Her approach was to talk to me about my need to exercise. Of course, I knew that exercise was important, but any past attempts on my part quickly failed, and I explained that to her.

She was unmoved and told me that I needed to exercise for an hour and a half a day vigorously.  By vigorous exercise, she was referring to a cardiovascular gym routine. She didn’t stop there; she also wanted me to do non-vigorous exercise for several hours a day. The non-vigorous activity would include things like walking, swimming, and biking. I tried to explain to her that I had difficulty climbing even a single flight of stairs. I told her that I knew that I needed to exercise, but I hated it and just couldn’t get myself to do it. I told her that I was working 60-80 hours a week, and didn’t have hours to spare during my day. She was unmoved, and instead of understanding me, she told me an “inspirational” story of a client of her’s (a former athlete) who had adopted her strategy and lost weight.

If you are or have been a fat person, you will understand what I am about to say next. I listened to her and felt even more hopeless about my plight; I gave up. On the surface, it appeared that I was paying attention as I nodded in false agreement. I left the appointment feeling worse than when I went in. I never adopted her exercised advice.

Fast forward to 5 years ago. My friend Tom was on his fitness journey and mentioned to me that he would buy me a coffee if I walked to the local Starbucks the next morning. I liked spending time with Tom, and so I was motivated to attempt this request. Further, one of the few exercises that I did like to do was to walk. With that said, I was uncertain if I could withstand the trip, and so I walked the route the night before, just to make sure.

That was five years ago, and I now exercise on (almost) a daily basis. That exercise has varied over time, and for the last several years, I have resumed my early morning walk to Starbucks. I look forward to talking this 3.5 mile round trip for several reasons. First, I love walking in the quiet of the early morning. I think, pray, meditate, and problem solve during that time. It isn’t uncommon for Tom to surprise me with a Starbucks visit, and of course, I enjoy that. However, I now know other regulars at the shop who greet and chat with me, as do the baristas. I bring along a computer on my walks, and I write most of these blogs at Starbucks. Starbucks is where I also write letters and emails to friends and family. By combining exercise with several other things that I like to do, I have transformed a negative into a positive. I certainly can now climb a flight of stairs without feeling like I need to call 911.

Writing a blog post after walking to Starbucks.

Method 2

Learning from past mistakes.

If you read my last post, you know that I’m currently on a spiritual fast. I have been on many restrictive weight-loss diets, and I have also tried a couple of spiritual fasts in the past, and so I had quite a bit of data to draw on to explore what kind of a fast that I could do that would have the greatest success of completion.  

Before I started this fast, I did a mental review of what worked, and just as importantly, what didn’t work with prior attempts to modify my eating. Based on this information, I devised a fasting plan that I thought would be challenging but doable. I’m now at the midpoint of this fast, and so far, I’m reasonably on target. 

This technique goes beyond personal growth; it can be applied to all levels of a human’s life. Does it always seem that you are getting the short stick when it comes to relationships? Look at the data. Is your career not moving the way you want it? Look at the data. Are you feeling like others are always taking advantage of you? Look at the data… and so on.

Explore the weaknesses in your behavioral patterns and find workable solutions to change them. If plan A doesn’t work, find a plan B. Reassess both your behavior and progress regularly, and modify as indicated.  

My plan is to have only bread and non-caloric drinks for two of my meals.

Method 3

Eating the elephant

One of my favorite sayings is, “How do you eat an elephant? One bite at a time!”  

The home that I have lived in for thirty years has both a basement and crawl space. Both have become “junk magnets” over the decades, with the crawl space being the more pathological of the two. Any object that we no longer used but still seemed useful was buried there. The only things that we did need to store there were our Christmas decorations, and these items occupied a small portion of that vast space. The rest was filled to the brim with boxes, bags, and loose items.  

It is difficult to get into the crawl space, and once inside, you have to stoop down and crawl on very rough concrete. The idea of cleaning the area out was not only overwhelming to me but also my wife. It was just easier to pretend that it didn’t exist.

However, now that I’m retired I have the time to tackle such a project, but I didn’t want to do it. I don’t like the feeling that I have something hanging over my head, and I don’t like feeling guilty. With that said, it seemed like an impossible task.

What I needed to do is to come up with a plan. What could I do to solve this problem? I wasn’t dealing with a deadline; I had as much time as I needed. My idea was to remove three significant objects from the crawl space every week. An object could be a big box, a large item, or a garbage bag filled with loose pieces. To make it easier for me to navigate the crawl space, I found my old knee pads and my headlight. I place these items by the entrance to the crawl space, so they were at the ready, making my explorations easier.

The purging process went on for months, but doing it was simple — one box per trip, three boxes per week. Since I only had three weekly items, it didn’t even add a lot of work to my “garbage night” haulings.  

Instead of thinking about how much more I had to do, I would celebrate that one less box was in the crawl space. I would pat myself on the back for accomplishing my job, which often only took a few minutes. Each “bite of the elephant” seemed trivial, but eventually, I ate the whole elephant.

Some changes in life must be done immediately and wholly. If you want to stop smoking, you need to apply total abstinence to increase your chance of success. However, many changes can be made gradually. Just have a real plan and direction. 

The crawl space finally cleaned out…one bite at a time.

So there you have it — three ways to change behavior. There are more ways that I may share with you in another post.

Cheers!

Mike

The Crawl Space

I moved into my home on Sunnybrook Drive in 1989, over thirty years ago. I purchased it for one sole purpose to give my daughter a stable and secure environment. I bought a four-bedroom, two and one-half bath dwelling for myself and my daughter, who visited me every other weekend. Overkill, you ask? I’m am a person who gets confused in chaos, and in my home, I had more than enough space to have a place for everything and to put everything in its place. 

In 1993 I married Julie, and we decided that we would start our married life together in my house. This made the most sense as she was busy getting her Ph.D., and my house was move-in ready. Julie brought to the marriage the contents of her old apartment, including a few boxes of things that we had no use for but were too “good” to throw out. These boxes served as the nidus of growth in the hidden part of our home, known as the crawlspace.

You enter the crawlspace from our basement, climbing into it from the furnace/utility room. It is a large, hollow area situated directly below the family room. The floor of the crawlspace is a hunk of very rough concrete and the short height of the room forces exploration on your hands and knees. This uncomfortable experience is made worse by looming joists and ventilation ducts that seem to be pleasured when you bang your head on their hard surfaces. The crawlspace tends to be more humid than the rest of the basement. Dark, dank, and dusty; its only redeeming value is that it is hidden from view. 

Over time boxes entered the crawl space, and once in, they never left. Our family grew from three to six, and with each child, there were clothes to save, and toys to box. Both Julie and I stored full sets of old heavy outdated luggage. I had a complete set of china that found a home there when our wedding dishes replaced it. Boxes of school notes, old textbooks, VHS tapes, and personal journals were tossed there. An end table, an electric “wonder oven,” a deconstructed shelving unit, kids Halloween costumes, broken tools, and an endless sea of Christmas decorations.

The Christmas decorations deserve special mention. For many years I would buy Julie a special Christmassy gift at Christmas. Porceline villages, giant snow globes, fancy nativity sets, and more. I also had a habit of purchasing super tacky animated Christmas novelties to surprise the kids. There was the talking Chrismas tree, the Jazzy Santa, and the dancing snowman, to name a few. All of these items found their way to the crawl space keeping company with boxes of ornaments, wreaths, lights, and our bulky fake Christmas tree. Julie didn’t like or display my Christmassy surprises, which achieved permanent residency in the crawl space. The kids did enjoy the Christmas novelties, but their poor construction combined with the damp crawl space warranted their quick deaths. Once in the crawl space, they joined other useless items creating our very own island of misfit toys. After thirty years, the island was bursting at its metaphorical seams.

My coping strategy was simple; I pretended that the crawl space didn’t exist. However, every time I replaced the furnace’s filter, I had to confront this delusion. I would glance at the area and quickly turn away, ashamed. However, even a glance would force a feeling of urgency in me that I needed to do something, anything, about the mess. I countered that urgency with the reality that I didn’t have the time to tackle such a project. I was working two jobs while trying to be a good husband and parent. That was what I could do. 

In 2019 I retired; I no longer had two jobs. In 2019 our youngest child entered college; our kids were grown. It was time to deal with the crawl space.

Julie had no interest in being a co-cleaner, and I can’t say that I blamed her. The thought of spending countless hours crawling on hands and knees was not my jam either. I knew that I needed to approach the problem differently. Those boxes, bags, and loose items had been squatting in the crawl space for years; they didn’t need immediate eviction. 

I developed a simple and nearly painless strategy. Three times a week, I would go down into the crawl space, and each time I would remove one item. That item could be a garbage bag of loose things, a storage box, or a single larger item. Each session would last (at most) 10 minutes, and once I completed my goal, I made a conscious effort to pat myself on the back. This also meant that I only had three additional items to take out in the trash every week, making Julie, the sanitation worker, and me happy.

I started this process several months ago, and I have been faithful in its execution. Initially, it seemed like I was making no progress, then the chaos of my actions made the space look worse. I knew that this would be the case, and I pushed forward. Now, several months later, I still have a way to go, but I can see progress. I hope that I will regain crawl space order in the first quarter of 2020. With that reality, there is also the awareness that the empty spaces could serve as a magnet for future clutter. I will need to be vigilant to continue to keep the crawl space clutter-free.

Life can be like my crawl space, chaotic, and full of unwanted things. Full of habits that no longer serve a purpose, but you can’t seem to discard. Packed with relationships that hamper you and hold you back instead of propelling you forward. When life is full of such clutter, there is no room for progress as all energy is used to maintain the status quo.

When humans face severe problems, most want rapid and easy solutions. We buy silly potions that promise miracle results or go on radical exercise programs that are abandoned as enthusiastically as when they were initiated. We quit unrewarding jobs without a back-up plan. We run from one relationship to another, seeking someone to make us feel complete only to find that we take ourselves with us. 

Most significant problems are not solved quickly or easily. It can be overwhelming to contemplate making a change when dealing with a substantial issue. However, it is often possible to make small changes in a dedicated and consistent fashion. Initially, it may seem like your efforts have no impact, then things may even seem a bit worse, but eventually, you will see the fruit of your labor. Just as in my crawl space, it is essential to remain ever vigilant to not fall back. 

Accept responsibility and approach change with a discerning eye. Your best life is ahead.

I hope to have the crawl space cleaned out by the first quarter of 2020.

Every Day Is Saturday

My birthdays have become important markers for me over the last few years. Their significance is less about my ever growing age, and they are more about a reflection of my previous year and a projection of my future one.

Last year I retired from private practice, but I continued to work 3 days a week for Rosecrance in Rockford. I also turned 65 and had a big party. Julie had asked me if I wanted a celebration get-together and she was surprised that despite my introvert nature I said yes. It was a most significant day as guests took the time to write remembrances of me that are now part of a scrapbook for my children and grandchildren.

Last year gave me two additional days of free time a week that I had initially planned to use in a concerted effort to improve myself and change the world. Reflecting one year later I did not change the world last year, but I did improve myself, just not in the ways that I initially envisioned.

Goals, like learning a foreign language and improving my guitar skills, fell by the wayside. Learning a language seems almost impossible with my poor auditory discrimination. It is likely that I will eventually focus more on my guitar playing, but I’m just not feeling it at the moment.

As far as changing the world is concerned, I think my grandiosity got the better of me. I believed that I could focus my passions for photography and writing, and combined these passions with my knowledge of human behavior to create a product that would have some sort of impact. I’m reassessing this goal, but not my passions.

It appears that my impact on others is much more significant when applied locally, rather than globally. This is something that should have been obvious to me as this has consistently been the case throughout my life.

I continue to write, and I believe that my overall writing has improved throughout this year. However, it is unlikely that I will be nominated for the blog hall of fame. I write now for the pleasure of writing, and to leave a chronicle of my life and ideas for my children and grandchildren. If my words impact a reader, all the better.

My photography has continued and is flourishing. I am doing a tremendous amount of architectural photography for my friend, Tom. Other photo opportunities are also presenting themselves, and in the next few weeks, I’ll be the contracted photographer for a Daddy/Daughter dance and a 50th wedding anniversary church service and reception. I have to say that I love the variety of doing different types of photography. Each presents its own kind of planning and method. My photos won’t be on any magazine covers, but I’m getting tremendous pleasure creating them as I think that they are serving a purpose higher than my own self-serving pleasure.

I feel most at peace in nature, and one of my goals has been to give myself the ability to experience the outdoors in the most cost-effective way reasonable. I don’t want the barrier of money to stop me from getting out among the trees. I am pleased to report that I am moving forward on this goal. Last summer I purchased a bare cargo van, and I have been in the process of converting it into a useable camper for one or two. Such a vehicle opens up many cost-effective possibilities for discovery. Last summer I had the initial interior shell installed by Wayfarer Vans in Colorado Springs, and since then Tom and I have been outfitting the van with vents, solar panels, and many other refinements. I now have a fully self-contained off-the-grid camper at the ready. I have already used it to travel on a few small trips and in May I will use it to meander to Arizona. Later in the summer, I will mount a trip to Glacier National Park. I am hoping that these trips will not only be soul cleansing, but they will also give me a chance to do more landscape photography. In addition, I am interested to see how my writing will change when I’m surrounded by pine trees instead of concrete.

I am doing things that were not part of last year’s plan. I’m learning more about construction; something that I enjoy immensely. I am also picking up a hobby that I abandoned over 15 years ago, Amateur Radio.

You may recall from previous posts that I have always loved radio, and as a grade school kid, I was building complex radios to exploring the airwaves. My private psychiatric practice was located by a lot of technology companies, and it wasn’t uncommon for me to treat scientists and engineers. In 1999 I had some knowledgeable experts warn me about the uncertainty of Y2K, and I eventually took them seriously. I felt that it would be important, not only for my family but also my local community, to have a way to communicate in a scenario where traditional communication lines were down. The apparent solution was Ham Radio, and I set myself a goal to obtain my radio license. In short order, I got a Technical Class license, then a General Class license, and finally the coveted Amateur Extra license. In my typical compulsive manner, I explored and bought radio equipment and practiced the art of using that equipment to make over-the-air contacts. My primary interest was in long-distance communications, but my small suburban lot didn’t have space for a proper antenna. Add to this reality my very long work schedule and the responsibility of raising young children, and I abandoned the hobby after about 3 years. I felt that I would never return to it.

I mentioned that I am planning a trip to Glacier National Park this summer, which has no cell coverage. Julie will remain at home during this trip, and I was thinking about ways to keep in touch with her. I explored the tools at my disposal, including my Amateur Extra license. In many ways traveling to a remote location is similar to having your community communication grid go down. No phone lines, no internet, no cell service. Ham radio could provide a communications solution. Unfortunately, Julie doesn’t have an amateur license, and so it would be illegal for the two of us to communicate over their air. However, there are options and the one that I plan to deploy is called Winlink. This is a protocol that allows the sending and receiving of email over the Ham radio bands. The recipient gets an email via their email client and can respond to that email just like they would any other email.

I have not been active in Amateur Radio for almost two decades, and I have forgotten much of what I had formally learned, so I’m now in the process of giving myself a crash course in electronics, radios, and communication law. You may think that my efforts are unnecessary and excessive, but that is the way I roll. I love learning and growing in knowledge.

Last week I had a much quieter, but equally lovely, birthday. Last Thursday Rosecrance also had a retirement reception for me. It was wonderful to be recognized, but also a bit sad as I’ll be leaving people that I have become fond of.

This week I will work today and tomorrow. This Friday my work life as I know it will be over. Some of my current activities may eventually fade from interest, but my life history tells me that there will always be new interests to take their place. Every day has become a new adventure and soon every day will be a Saturday for me.

Life is good!

A quiet but wonderful 66th birthday.

A retirement reception at Rosecrance.

Retirement, many changes.

Lessons From A Simple Average Day

Stumbling downstairs I greeted Mercury, our jet black cat. She meowed an acknowledgment and followed me into the kitchen. Her affection a guise for her true motives, the acquisition of a treat. Her goal met, she looked up at me in a thank you glance and sauntered off to perch herself on top of her favorite comfy chair.

Sticking a K-Cup into my Bunn single serve coffee pot I pressed the brew button. Hot brown liquid squirted into my Smoky Mountains earthenware mug. With each sip, I became more alert and focused.

Grabbing my old brown leather messenger bag I shoved my MacBook into it. I knew that I would not be seeing my friend, Tom, for coffee, and for an alternative activity, I stuffed several articles on Medicare into the bag’s back compartment. I have to admit that I had been avoiding reading these articles, as the fear of making a catastrophic health insurance mistake had immobilized me. However, it was time to take my head out of the sand and move forward.

Heading out the door I was instantly smacked in the face by a blast of cold, wet air. I glanced up to the streetlight in front of my house to see a fine mist silhouetted against its bright backdrop. For an instant, I thought about returning for an umbrella, but the mist looked light, and my red Columbia jacket has a weatherproof hood. As I walked the mist turned to rain. I continued to move forward.

Greeted by a friendly, “Hello,” I entered Starbucks and ambulated to the counter to order a Tall, Veranda. It was then time to coordinate my Medicare articles with their corresponding websites. One YouTube video offered a fee Medicare guide, and I signed up for it, an action that I regret, as their salesforce called me at least a dozen times.

It was election day, and I determined that I would walk to my polling place from Starbucks. Unfortunately, the rain had increased in ferocity. My jacket had reached its saturation point, and the dampness now enveloped me.

At the polling place, an unknown elderly lady election judge recognized me. “You are Doctor Kuna! You delivered my Mary! She announced this to several other officials around her. I could not place her, but I surmised that I possibly treated her in the distant past. I smiled and quickly moved away as I didn’t want to get into a conversation that would reveal that I was a psychiatrist, not an obstetrician. Her private life was hers to keep.

Back home, I contemplated taking a hot shower but elected to drip dry instead. On the computer, I watched a few videos from Dale Calder, a retired man from New Brunswick. I stumbled on his videos by accident, and find his slow and deliberate style peaceful and engaging. He often records his videos from a tiny micro cabin and chats with his viewers while he makes comforting meals on a wood stove. He has a quality about him that makes me feel like he has invited me into his cabin for a cup of tea and quiet conversation. I value his Zen-like “appreciate the moment” way of living.

Watching his videos inspired me to explore camping cooking, and I pulled out my little butane stove, the one that I bought at H-Mart over a decade ago. I then assembled my 20-year-old Coleman camp oven. If Dale could make shortbread on a wood stove, certainly I could do more than warm up a can of soup on my little burner.

I elected to make breakfast and decided on blueberry pancakes, as I had a small clutch of dehydrated berries left from a previous camping adventure. Flour, egg, baking powder, salt, milk, melted butter, each item was measured then mixed in a big red melamine bowl. Last went in the blueberries, and my yellow slurry instantly turned a bright purple.

I lit the butane stove and placed on it my 10” GSR camping fry pan. If I was going to do camping cooking, I was going to use camping equipment! I heated oil until it popped with a test drop of water and then poured in three pancakes. I only made a small amount of batter, and the job was quickly completed in two runs. A pat of butter, a smear of sugar-free apricot preserves, and a squirt of sugar-free syrup, breakfast was served.

Encouraged by my success, I placed the Coleman oven on top of the stove and lit the fire. I mixed another batch of batter, this time for sugar-free muffins. Fingers crossed, I set the muffin tin into the Coleman.

As my muffins baked, I searched the basement for my GoPro video camera. I located it and contemplated how I might use it in a “Saving Savvy’ video that I was thinking of making. The muffins continued to bake as I searched for my tripod and audio recorder. My nose informed me that they were done. Success, and a perfect complement for the vegetarian lentil soup that I was planning for lunch!

Guilt overtook me as I looked out at my front lawn, which was covered with a thick carpet of leaves. My next door neighbor has a meticulously kept lawn, and the wind was blowing my leaves onto his grass. I really despise raking leaves, and so I decided to turn my task into an experiment. Learning something new always makes a dull job more interesting. The question: “What is the best gadget to remove leaves, rake, blower, or lawn mower?” Each section of the lawn was tackled by a different method. The result: Mowing was the fastest, while raking gave the best overall results. I knew that this was no great discovery, but it kept me at the task, and I finished the job.

A few more random jobs ebbed away the rest of the afternoon. Will returned home from school, followed by Julie coming from work. I sat with them as they supped on a dinner of leftovers: spaghetti, bits of turkey breast, and reheated crescent rolls. I nibbled on some of the turkey but deliberately avoided a full meal as I was having dinner with my sister later in the evening.

At 6:45 I hopped into the Promaster and drove 15 minutes to Panera Bread. Nancy had already arrived, and I sat down across from her as I waited for my order of squash soup. It eventually came, and I sipped it while I caught up with the news of her family. I have been meeting with my sister every Tuesday night for the last few months. We are both writers, and our meeting’s purpose is to mutually support each other as we try to improve our writing skills. Beyond this function, it is wonderful to regularly meet with Nancy, as we genuinely enjoy each others company.

By 8:30 our meeting had concluded, and it was time to head back home and to the pleasure of a long, and scorching hot shower. Julie and I chatted a bit, and the day concluded.

All in all, a wonderfully average day.

Dear reader, you may be asking why I am writing about my day. There are several reasons. The first is that I am ever trying to appreciate being in the here and now. The day that I described above is never to be repeated. To dismiss it would be a negation of 24 hours of my life. Although typical, the day was filled with learning new things, experiencing new things, connecting with others, and doing productive work. How often have I ignored such days, as I focused on vacations and other spectacular outlying experiences?

I am making an earnest effort to celebrate each event and every connection. I am getting better at this effort. This improvement was not caused by a significant life event; instead, it was seeded by the ticking of time. When I semi-retired in January, I felt an urgent need to do the next big thing. Over the last 11 months, I have come to realize that life isn’t about the big stuff, it is about all things. Happiness can be found by appreciating and savoring every experience. Making breakfast becomes an adventure, raking leaves an experiment, meeting with my sister a growth experience, taking a hot shower a pampered luxury. Everything has significance. It is crucial for me to focus on this truth, instead of discounting a typical day as just something to get through.

I am uncertain if my writing and photography will ever reach a broader audience. However, it gives me pleasure to think that you have taken the time to travel on this journey with me. Along the way, I hope that you will also open your eyes and your heart to all of the experiences that you are given on a daily basis. One step in front of the other, moving forward together, not alone.

Peace.

Feeling proud (and damp) after voting.

Camper blueberry pancakes with sugar-free preserves.

My 20-year-old Coleman oven seated on my camp stove.

Yummy sugar-free muffins, camper style.

Chinese Halloween

I grew up in the 1960s, and at that time Halloween was a minor holiday celebrated by young children. My costumes were usually homemade and pieced together from existing house items. A favorite resource was our kitchen closet, which was never pruned of its contents and therefore it was a treasure trove of costume building materials.

I would often adopt the persona of a hobo. I would find a worn flannel shirt and a beat up fedora in the closet and paint on a pseudo-beard with a piece of burnt cork.

Costumed, it was then time to meet my best friend, John, for our trick-or-treating adventure. Our goal was to get as much candy as possible, with our journey ending when the street lights came on. Once home I would pour out my bag’s contents onto the living room carpet and start my sort. If I had gone to enough houses, there would always be a few full-sized candy bars, and these would be my most prized finds. I was guaranteed to have a lot of mini-candy bars and other cellophaned sweets. Naturally, I would have random Many Janes or peanut butter kisses, so disliked by me as they were usually rock hard and inedible. And then there were the items that would make a direct trip to the garbage can: apples, homemade popcorn balls, loose candy corn. These items were considered dangerous as some maniac could possibly alter them with razor blades or injected rat poison. This urban myth fueled by the annual TV news story of kids having their candy x-rayed at a local hospital for pins, razors, and shards of glass. As far as I know none of the above were ever found, but I wasn’t going to die by biting into a poison apple, and so I willingly tossed all suspicious items.

Sorting done, it was now time for hiding. Seven of us lived in our small Chicago bungalow, and hiding spaces were scarce. Despite my efforts, it wasn’t uncommon to find the best candy treasures missing by the next morning, stolen by my older brothers. With limited recourse, the only option was to move on and focus on the next big holiday, Thanksgiving.

My Halloween adventures abruptly stopped in the 5th grade when a crabby lady loudly shamed my friend John and me for being, “Too old to trick-or-treat.” It was time to move on.

For many years Halloween was insignificant. I would attend an occasional Halloween party, but that was about it. This latter fact changed when I started to date my wife, Julie. Together we experienced what we now refer to as the Chinese take-out incident.

Twenty-seven years ago Julie came over to my house on Halloween, and we decided to order Chinese carryout for dinner. I had in my possession a giant magnum of very high-quality champagne. It had been gifted to me by a friend the prior Christmas. I have to confess that I know little about champagne and that I’m a pretty lightweight drinker. However, I knew that champagne does not improve with age, and so I decided to uncork it for our Halloween feast.

We sat at the kitchen table noshing on Mongolian Beef and potstickers while we drank the champagne, served up in paper cups. I couldn’t detect much alcohol in the beverage which tasted a bit like apple cider, and I kept on pouring out drinks because I knew that its fizzy goodness would be gone by the next day. No sense wasting it!

Every 30 seconds the doorbell would ring. Initially, Julie or I would go to the door. However, in short order, we were both rushing to the door to hand out candy. With each paper cup of champagne, our food seemed more delicious, our conversation more fascinating, and the costumes more amazing. Who knew that Halloween could be so much fun! Unfortunately, the joy faded and was replaced by headaches and significant malaise. That evening I learned that champagne and carbonated apple juice are two very different things.

Years passed, we married and had children. It was time for new traditions. When my kids were younger, there were the requisite trips to Bengston’s Pumpkin Farm, which seemed to get even more commercial and expensive with each passing year. Then there was pumpkin carving day. Each of our kids would tell me what kind of face that they wanted on their pumpkin and I would do my best to create it. In the early days, I did all of the carvings, but each child was expected to eviscerate the slimy innards from their respective fruit. I always seemed to carve just a day or two too early, and by Halloween, our masterpieces were gooey messes.

My kids made mostly homemade costumes, not by need, but by choice. Sometimes they would dig through our box of dress-up clothes, at other times we would go searching the Halloween store for the right wig or grease paint. I recall one Halloween when I was covered with red spray paint, the result of the Lego costume that I made for Will. One of my favorite memories is walking with my kids as they went door to door. Although I stayed on the sidewalk, I was still able to relive my own Halloweens from days gone by.

Just like me, they would pour their bounty on the living room floor and sort. The girls were especially happy with this protocol, as William didn’t eat chocolate. In addition, he was the youngest. Four mini Snickers for a single Twizzler? Will was delighted to make the trade. Where I came from a “want” model, my kids live in a “plenty” one. Their candy would sit on the floor for days until I would set a strict limit. I have to say that my anger was tempered by their generous gifts of Kit Kats and Reese’s Peanut Butter Cups, two of my favorite candies.

As I write this my oldest daughter has a family of her own, the next two are in college, and my William is almost 18. This year there was no Pumpkin Patch, no Carving Day, No costume creation, no Halloween walk, and indeed no champagne.

Instead, we sat around the kitchen table eating Chinese carry-out, having fascinating conversation, and running to the door to see the kids dressed up in their amazing Halloween costumes. Some traditions come, some traditions go, but it seems like Chinese Halloween is here to stay.

The kids were expected to eviscerate the fruit’s innards.

Grace as a grape

 

Kathryn as a doctor, Grace as a cat

Will as Santa. His friend James as a mushroom.

Yes, we did have Chinese carry-out this year

Change Your Life With A Gratitude List

Why is it that I can focus on a single negative in my life while ignoring so many positives? How can I change this waste of energy?

I think my thinking pattern is similar to many others. I can let a single worry dominate me. Typically, I find that this stance is a waste of my time and energy. Yet, I continue to do it.

I have made attempts to change my behavior, and some of my efforts have been more successful than others.

I have gotten better at letting go of trivial slights. The driver that cuts me off no longer spoils the rest of my morning.

I also employ cognitive techniques to correct my perceptual distortions. When I get upset about something, I will pull back and logically explore the problem and reframe the information at hand in a more realistic way and less catastrophic way.

Also, I work hard to let go of situations that I have no control over. I’ll, “Let go and let God.”

The above techniques all fall into what I would call a pathology model. In other words, they focus on lessening my current worries. The problem already exists, and so I actively treat it.

Good doctors not only treat problems they also practice preventive medicine. I would like to think of myself as a good doctor and what I advise my patients can also apply to me. So how do I prevent worry? There are many ways, but the one that I would like to share with you today is called a gratitude list. This technique is simple, but it does require some practice and thought.

The positives in my life far exceed the negatives. However, I can take my blessings as expectations and thereby ignore their significance. A gratitude list is one way to acknowledge these good things, and when I do this, I automatically have a more positive outlook of my life.

Here are the steps I use.

-Once a day I think of 3-5 things that I’m grateful for. They can be significant things or minor things. For instance, I might be thankful for my health (major thing), and I also may be grateful for having coffee with a friend (minor thing).
-I make an effort to vary the things that I’m grateful for. In other words, I don’t repeat the same list every day.
-Sometimes I’ll write down my gratitude list, sometimes I’ll only make a mental note.
-I don’t just write down a list, I also think about each example on that list. I may recall that I’m no longer on any medication and that I’m able to walk long distances once again. I might think about a walk that I took and how much I enjoyed it. For my second example, I may be grateful for having people in my life who want to spend time with me. I might remember the conversation that I had during my coffee klatsch, or how much I enjoyed the taste of the coffee.
-If possible, I recall my gratitude list during the day, repeating the above technique.

When I first started this daily exercise I had trouble coming up with unique things to be grateful for. However, over time, it became easy. The trick is to limit your list to a manageable number. I find that 5 examples works for me. I want to have time to think about my list, I don’t want to write down a lot of meaningless examples.

By doing this exercise regularly, it has become evident that I have much to be grateful for. When I think about my life in positives terms I feel more positive about myself, I attract more positive people, and many of my problems feel more trivial. All of these benefits for the cost of a little time!

I would encourage you to make a gratitude list every day for the next 30 days. Let me know if it makes a positive difference in your life. If the answer is yes, it is easy to incorporate a gratitude list into your daily routine.

Dr. Mike

A Coffee Date With Nancy

The date was set, we would meet at Starbucks at 7 PM. Not the Starbucks that I usually go to, but one on the far side of town. We had talked about this for months, and now we were finally doing it. At the very least it would be a fun adventure; I had nothing to lose.

I arrived at 6:59 and found a quiet table. I went up to the counter and ordered a Tall Pike’s, decaf. Moments later my phone rang, it was Nancy. She was outside the store trying to park her car, but the available spots were all blocked by a police prowler. The officer was apparently thinking that his convenience was more important than preserving three open slots for other customers.

Soon Nancy was sitting across from me, and we started to talk. First small talk, then more about what was going on in our lives. However, this chit-chat wasn’t the reason that we were meeting, our conversation was just a common preamble.

We reminisced and evoked memories from past years. Nancy, 7 years my senior, my friend, my older sister. We had decided to meet to explore our creativity. Like me, Nancy is a writer. Like me, she is trying to find her voice. Unlike me, she has studied her writing motivations though workshops and creativity groups.

Nancy tried to focus me. “What do you want to write? Fiction or nonfiction? What is your passion? Who is your audience? What is their age range? What topics have gotten you the most hits?” Questions that I never thought about.

So, dear reader, what is the purpose of this blog?

Drmikekuna.com was created as a writing exercise to see how far I could push myself in a public forum. As an introvert, I’m naturally reserved and private. However, to write effectively, I need to break through these limitations without fear of judgment from others. I also created this blog as a record of who I am. Eventually, I’ll download its contents onto a memory card and place it with other momentoes of me. Cards and letters that were written by patients when I left my private practice, notes from loved ones who wrote memories of me to commemorate my 65th birthday, and other things. I want my children and grandchildren to have a broader understanding of me. I want to be more to them than a few scattered recollections.

Like most things in life, my blog has evolved. It continues as a writing experiment, but there has been a shift. I now let my flow of consciousness take over as I write. It seems that my posts eventually evolve into some sort of life lesson. I find this new process interesting, but I have no idea if anyone else does.

I am trying to find myself, and redefine my purpose. My professional life has been a life or providing service to others, and I feel fortunate that I have had the opportunity to do so. However, I am entering a new season of my life, and my energy has shifted. I still want to contribute to the world, but I want to do so by engaging other talents. Specifically, writing and photography.

I need to determine what my goals are. Am I writing for an audience of one? Has my blog become a journaling exercise that would be better accomplished if it was done privately and within the confines of a spiral notebook? Should I abandon the blog and start the daunting task of developing a book? If so, what would my topic be? It is clear that my writing would reach a broader audience if I focused it on popular issues and selected demographics. Do I want to do that? Do I want to become more commercial in my writing? Would such a change remove the pleasure that I derive from my current spontaneous musing?

It is clear that I have just started this journey. I will meet again with Nancy next week as we continue to examine how we can support and help each other in our pursuits.

Dear reader, as I move into retirement, I am aware that I not only need to be flexible but also realistic. Grandiose ideas and plans can fuel the genesis of any new project. However, work, reassessment, and realignment are the real building blocks of growth.

Do you have goals and dreams? How are you approaching them? How are you redefining them? Let’s grow together!

How Doctors Should Talk To Patients About Obesity, An Open Letter To Doctors

Last week I had surgery, a long surgery that required over an hour of operating room time, but the operation was not my greatest fear as I approached this process.

What concerned me the most? I feared having to get a pre-op clearance from my internist; a simple visit that would require less than 10 minutes of contact time. You may be thinking that my primary care physician is mean, rude, and evil. Of course, this is not the case. He appears to be a nice man and a good doctor. If I felt otherwise, I would not work with him.

So Dr. Mike, what is the problem? First a little more background information.

As a person who has battled obesity all of my life, I have become acutely aware of the stigma that comes with weighing excess pounds. Few human attributes can be ridiculed and condemned in the millennial “microaggression” culture of 2018. Imagine criticizing or mocking someone because of their race, sex, religion, sexual preference, gender identity, physical stature, or a multitude of other differentiating human characteristics.

Making fun of “fat people,” is an acceptable national sport, even though the CDC reports that over 70% of adults in the US are now overweight. Of course, as the overweight population explosion redefines the concept of what is normal weight, there will always be those outliers who exist beyond a standard deviation from that norm. There will always be a group to abuse with fat jokes, both overt and covert criticism, and outright disdain. If you are obese, it appears that it is OK for others to assume that you are lazy, dirty, and stupid.

We would never make such assumptions for other medical epidemics. Imagine someone undervaluing you because of your high blood pressure, or your fasting blood sugar? Just like obesity, these illness are caused by multiple factors: genetic, environmental, and lifestyle. Unlike obesity, there are good medical treatments for these ailments, making them easier to treat. The majority of folks with high blood pressure can significantly reduce health risks with medication management alone. However, the majority of obese people will continue to be fat despite diet plans, medications, exercise, and shaming television shows.

I lost over 100 pounds about 3 years ago. I did this after failing many traditional techniques of weight loss. I feel that my weight loss was indeed a miracle that was fueled by common sense, rather than modern medicine.

We are humans, not machines. We are motivated and influenced by a multitude of factors. This variability can be considered a weakness, but it should also be acknowledged as one of our greatest strengths. We are complicated, and as such simple blanket solutions have marginal utility.

Over the three years since I lost weight, I have regained a small percentage of my weight. Most people have told me that I look better with a few extra pounds. They say I look less gaunt, and more vital with this increase. Additionally, I have long shifted from judging myself based on a number on a scale. My lifestyle changes have been just that, they are not strategies to lose weight and thereby achieve some sort of false utopia. “My life will be good if I am not fat.”

Three years into this process:

I still can wear my same wardrobe.
I still exercise every day, walking from 3.5 to 8 miles.
I still avoid all forms of concentrated sugar.
I still practice healthy eating.
I still make an effort to eat more natural foods.
I still assess and correct hidden forms of weight gain, like emotional eating.

When I determine my current status I would say that my efforts continue to be successful, but what about the matter of my small weight gain, does this one objective parameter signify failure? I would say, “No.”

************

I sit in a chair opposite from my primary care doctor who is staring at a computer screen.

“You have gained weight.” My doctor says. My initial impulse is to apologize for my failing. I resist. My second impulse is to defend my position. I resist and remain silent. “Are you exercising?” I reply that I am and had already walked four miles before our appointment. “But what about cardiovascular exercise?” He retorts. And so it went. Three minutes of questioning that felt like three hours of interrogation. Pain always feels worse when inflicted on an open wound.

***********

Dear readers, I’m am a resilient person. Besides, I am good at using the counterbalance of logic when dealing with my emotional exaggerations. However, there is more to this story than just a detailed account of me stepping on the scale and my emotional response to that event.

Being a physician, I understand the power that doctors have over their patients. Patients come to us in an extremely vulnerable state looking for help. Studies have shown that a statement like, “You need to quit smoking,” will convert some active smokers into former smokers. Unfortunately, in medicine one size does not fit all. It is easy for physicians to generalize the above truth and think that simple pronouncements can be used to motivate all lifestyle change. However, a doctor’s command is a partial solution at best, and should only be used when wielded within a broader understanding of what causes people to change.

Many of the illnesses that physicians treat on a daily basis have a strong lifestyle component. My weight loss eliminated my need for blood pressure tablets, high cholesterol medication, and a CPAP machine. So why is it that physicals don’t learn and employ simple motivational techniques so they can move their patients towards health? I don’t ascribe to know all of the answers to this questions. However, I do know some of them.

Physicians in the US work in a production model. We get paid by the volume of the work that we do. See fewer patients, make less money. As medical practices get bought up by business investors the push for physicians to do more continues to increase. A good business model consists of finding ways to spend less and make more. This fact is contrasted by a simple truth; we are caregivers, and most of us want to provide care.

Our contact with patients is reduced by the use of physician extenders. Someone else takes our patient’s blood pressure and obtains their chief complaint. We employ electronic medical records (EMRs), which provide a clear notation of our treatment plan, but does so at the cost of patient interaction. Patients now have the “privilege” of answering our questions as our eyes are focused on a computer screen instead of them. Patients want care from us, and we want to meet their needs. There is a pill for everything, and today’s EMR makes prescribing absurdly easy. Is writing prescriptions the same as providing care? I believe that it is only a part of our job, and it should not define us in total.

When I retired from private practice, I was fortunate to have patients write goodbye letters to me. Almost universally they said that they valued their time with me because I listened to them, didn’t judge them, and guided rather than controlled them. To do these things I needed to spend time with them. I would have made more money if I saw 6 people in an hour, rather than the two that I scheduled. However, I would not have known my patients as well, and more importantly, they would not have known me as well. Trust is a function of integrity multiplied by time. Trust by itself offers a positive corollary to patient satisfaction and well-being. Besides, a career that includes connecting with others is eminently more satisfying to we providers than one that does not. A win/win.

One factor needed to motivate change is time. Unfortunately, extending the length of appointments may not be possible in today’s corporate medicine climate. There are indeed a variety of stop-gap strategies that doctors can do to build a connection, such as deliberately spending a few minutes directly with the patient before turning to a computer screen. Such simple changes can make a patient feel more connected, but they still don’t address the elephant in the room.

How should doctors interact with patients to create change? Fat people know that they are overweight, and should lose weight. Alcoholics know that they drink too much, and should stop. Diabetics realize the importance of blood sugar control, and that they shouldn’t eat that extra donut. We live in a culture that shames, and it is likely that some will avoid being humiliated by their physician by avoiding seeking necessary medical care. I admit that I have been an avoider in the past.

Big problems become smaller when shared with someone. I am willing to tackle projects that I would not usually attempt when I have someone at my side. This phenomenon is even more evident if that “someone” has expertise that I lack. If you have been reading my prior post, you know that I have been converting a cargo van into a camper. I dare to significantly modify my van because I am doing the project with a friend who has expertise far beyond mine in such manners. We, physicians, have expertise far beyond our patients in such manners as health. Most reasonable patients accept this, despite the advent of the Internet. A colleague of mine has a cup in his office that reads, “Please don’t confuse my medical degree with your Google search.” However, most patient’s intrinsically understand our expertise, which is why they are seeing us.

Doctors need to connect with their patients as human being to human being, and they need to do this on a level that patients can relate to. We need to become trusted knowledgeable friends rather than overbearing, critical parents.

We need to understand where our patients are coming from, and how willing they are to make change. We need to problem solve with them. Imagine if my doctor asked me, “Are there any barriers that prevent you from seeking medical attention?” Or, “Are there any ways that I can help you with your lifestyle change?” Those simple questions would instantly change my relationship with my care provider. I would want to meet with him, and I would look at setbacks as problems to be solved, rather than justifications for criticism.

Once a patient’s cards are on the table, all things are possible. Is the doctor’s goal the same as the patient’s? What are the barriers to achieving the desired goal? What steps should be tried? How will progress be measured? How is a reversal of progress addressed? Empathy joins, criticism divides.

A meaningful connection with a patient doesn’t happen all at once. Relationships develop over time. However, imagine helping your patients make a significant and real change. Imagine the satisfaction of having a substantial connection with them. What would it be like to work with real people instead of being a reviewer of lab data? What would it be like to end your workday with the knowledge that you truly connected with someone in a meaningful and significant way that changed their life? What would it be like to move from treating diseases to treating people?

We blame our patients for their failings, while we steadfastly hold on to methods and techniques that simply do not work. Imagine if our relationships with our patients were more as a knowledgeable and caring peer rather than a stern and critical parent? Imagine yourself as the patient. You are aware that you have a problem and you need help. Who are you going to ask? Someone who tells you what you already know, makes you feel bad, and offers no real help? Probably not.

Patient Mike