After Your Visit

We need to know where we are starting from. “It’s commonsensical,” acknowledges Dr. William Crowley, TK at Harvard University, “but before we can establish goals or come up with wellness plans, we need know where we are right now. That is intuitively obvious to people and they don’t need much education on that. But they do need some, and this is part of the patient-doctor conversation. ‘Why are you doing this test? How come you’re not doing this test?’

Because there are so many tests an individual could undergo (at least potentially) in the course of a physical examination, patients need to know why some are included and why others are excluded. They need to see these decisions in the context of their own medical history as well as their family medical history.

These conversations never take place in a vacuum. “The positive trend we have today,” says Crowley, “is the web and social networking and patient groups. There is a huge amount of very good, very well ordered, simply described information out on the web about various diseases.” All of this information needs a personal context, however, and that is an individual’s own baseline. “People can easily come to see the value of accurate baseline information,” says Crowley. “That’s step 1 and it’s perfectly straightfoward: let’s see where you are now.” LESS

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Once you have a good baseline, explains Crowley, you have something you can compare. And yet, the usefulness of this isn’t as obvious as we might think. “When a patient hears a doctor say, ‘I’d like to see these results every 3 months or 6 months,’ it’s easy for patients to wonder why.”

A good example of the importance of serial testing, says Crowley, can be seen in hypertension. “We have so many patients who react to tests by saying, ‘I don’t feel bad; it’s only a number!’ So their doctors tell them that they are at risk for strokes and heart attacks and nearly all of them take their medicine. But here is the key: if you look at patients who are prescribed hypertensive medicine, less than one third take it for more than 3-6 months.”

The problem is that these people are stuck in seeing healthcare as crisis intervention, explains Crowley. “They are used to thinking, ‘I have pneunomia and I’ll take my pills and 10 days later I’ll be better.’ They see their medical history as a series of episodes, rather than a continuum.”

But we don’t have to stay stuck. The key, of course, says Crowley, is to look ahead. “To understand, in other words, that we want to lower their blood pressure so that 10 years from now they don’t have a stroke, that we want to keep their blood sugars down so 10 years from now they don’t have renal failure and blindness.”

Sure, that may sound simple, but if it was easy, we’d all see the long view and clearly we don’t. And, in fact, suggests Dr. Eric Goldberg, TK, “seeing” may literally be the solution. Think of all the numbers that are involved in a medical checkup, all that data, whether it’s cholesterol, or blood pressure or just weight. “I can show them all the numbers I want, but when I can turn those numbers into a simple graph, something visual and directly related them, it’s very powerful. These are your numbers, this is how they have changed over the past 5 years and this is where they are headed.” That line going up or down or holding steady is your personal health trajectory. LESS

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If motivation and change were easy, there wouldn’t be thousands of self-help books written on the topic year after year after year. Finding motivation and the means by which you can use that motivation to help bring about change in your life is going to be very personal to you. But as you explore these personal wellness issues, remember to:

• Tap resources. There is a tremendous amount of very useful information that is available to you, beginning with the healthcare professionals who will help establish your wellness baseline. Engage with them as though your health and wellbeing depend on it!


• Seek support. Yes, we need information, but we also need the emotional and social connections we find in friends, family and support groups. Sharing the process and your success (as well as the day-to-day challenge) with the people who matter most to you can be a powerful source of strength and motivation.


• Have a plan. For most people, setting goals, measuring progress and staying on track need to be broken down into bite-sized daily efforts. Keep the big picture in view by minding the little things.

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