Map of life expectancy at birth from Global Education Project.

Monday, January 30, 2012

Once again my passion to tread the boards is awakened

Believe it or not, I majored in theater (excuse me, theahtuh) in college and did quite a bit of acting in my youth. Got sidetracked by politics and science and whatnot but I do kind of miss it -- especially since I think I've figured it out and would be much better at it.

Anyway, I've been helping a colleague who is trying to train pharmacists to use Motivational Interviewing techniques to get people to take their pills. Actually it's more complicated than that but no sense getting into it. My mission is to role play a patient who is trying to control his blood pressure by losing weight and exercising and eating right and who believes he is succeeding based on his self-monitoring of his blood pressure at home.

Again, without going into further details or objections, this experience has driven home for me how very difficult it is for health care providers, of whatever particular stripe, to resist being Daddy. They typically see their job as getting us to do what they want us to do. That's okay, it's understandable, the whole point is they are experts and they're supposed to know what's good for us, otherwise why are they paid?

But there are major problems. If they don't actually know what's going on with us, they might just be wrong about what's good for us. However, if all they do is lecture us and threaten us with death if we don't carry out their orders, we are likely not to tell them what's actually going on because a) who wants to listen to that and b) nobody likes to be pushed around. In this case, the pharmacists saw it as their job to get me to take the pills, not to control my blood pressure. And they undermined my efforts to do it the natural way by insisting that hardly anybody could succeed at that so why don't I give up and take the pills? Having me not take the pills and keep losing weight would have been a defeat.

Now, admittedly, few people do succeed long term at weight loss and other behavioral risk modifications. That's why doctors give up very quickly and prescribe diabetes, hypertension, and cholesterol-lowering medications. On the other hand, half the people don't take the pills either. But they won't have an honest discussion with the doctor about that if all they'll get is flack.

Having played this part, I totally feel that way on behalf of my character. Supposedly the subjects have been trained and they're going to call me back and try again. I'll let you know how it goes.

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