FP

I am ending the rotation next week. It's been a great rotation for many reasons- FP is a nice sorta gig, as you can actually follow up and try to help a patient change their lifestyle so they might enjoy healthier living.

So, for the first week... My pt. (and this is the generic pt's- and believe me, there are a zillion just like this.)  DM-Type 2, NID, HTN Stage 1, add a bit of elevated BMI, a bit 'o drinking on the weekend- and maybe the weekdays. Maybe they smoke. Um. and the cardio they have (and this counts to them) is walking from the car to the door of their office.

Me:
So, you know that smoking (fill in the rest of the blanks) causes X,Y Z.
Pt:
Yes, I do. I have tried many times to stop. I just can't.
Me:
That's great! Keep trying. You can do it! There are ways that we can help you...(fill in the blank)
Pt:
Yeah, I got that patch/Pill/Gum once before. I stopped for a month/3 months/6 months and then started again.
Me:
Okay, well, I think that's great! Now, the next step is to try again.
Pt:
That sounds good.     Yeah, maybe I can do it.
Me:
Wow- that's great! So, comeon' back in 4 weeks, and we will talk again.

Fast forward 5 weeks:
Me:
So, how are you doing?
Pt:
Well, I tried x,y and z and I cut down to 19 instead of 20 a day.
Me:
Well, Good...now, what can we do to help that move along faster for you?
Pt;
Well, I am not sure.

So, reality is this: When they are motivated to change, they will. I hope that I motivated some one person to change their lifestyle just one smidge to make their lives healthier. But I am not sure. I admit my conversations now lean towards

Me:
Do you smoke?
Pt:
yes, about a pack a day
Me:
Okay, you know you're going to get the lecture. You know it's bad for you and I want you to know that when you decide to quit, we are here to help you in any way we can. Until you want to quit, there really is nothing I can do to help you.
Pt:
Thanks. I've heard it all before.

We all know that we shouldn't smoke. Should drink in moderation. Should exercise. Should not eat junk, but eat at home, healthy foods filling our diet. But we don't- okay, some do, and I admire them. But I know I don't always. This past year is a great example. I have been a sitting, unexercising, icecream eating slob. I swear that this will change- when?

When I am darn good and ready. But it's HARD and its internal. I know all the reasons to be good- including feeling better. But, other than that. it comes from an internal place that just don't have the ability to tap right now. So, developing the knowledge that it's hard- yet still mentioning it at each and every visit is essential. I also have to say I bring it up in my ED conversations (the joys of being a student- no clock on my head).  I hope to make an impression to my patients with advice on healthy living- and I'll keep trying to be an example.