The Galloping Gourmet, "I'm Looking Over a 4 Leaf Clover," Patients Who Do Not Wish To Return, and Leadership
In the evenings, Debra, our Helper Starter cooking teacher who can assist and instruct you at your home in preparing the tasty foods we recommend, calls our patients who either "no showed," cancelled their appointment, or for whatever reason are not returning. Debra called me stating that my message/form had to change: "I got you back two patients who had no intention of returning because you were too strong with the diet." She asserted I needed to make a career decision: be a doctor or become the Galloping Gourmet. Is this true? Do you think I am too strong for you and my other patients with the diet? Before you answer that, please read a little further.
Years of experience have taught me that those who do not wish to return, simply hear my words as an "ultimatum" (one of the very words Debra quoted that she heard repeatedly). As your employee, not as your employer, I am perfectly aware that what I do is offer advice ("An Invitation To Consider..."), but I command nothing: there never is an ultimatum from me. And I am fully aware and agree that I am not your boss!
But, why do you think I give this advice? Do you believe that I need counseling for aggression, or could it be that certain things are better for you than others, and this is simply where my strength is "for" you and "against" the potential problems? Do you believe that what I say is The Truth? Do you think behaviors have as much to do with health as I say? Why do I encourage you to eat certain foods, not others, be a particular weight, change your diet-exercise-smoking-attitude-coffee-alcohol-unprotected sex-etc.? Why on Earth would I take such a chance in offending you by suggesting you change many of the things that you like so much?
If you become upset with what I say, then you are (incorrectly) holding me responsible for the truth of your biology which is not subject to what either you or I like. (Ask me to explain the history of the word "marathon" to you.) Don't you know this is just being serious so we can prevent cancer/heart disease and stroke/high blood pressure and high cholesterol/gallstones/diabetes/etc.? I did not write the rules of health, I am merely the truthful messenger from your biology to your brain. Developing diseases comes from what you do wrong and/or not doing what you should. I am not judgmental, but your body absolutely is. With biology, it is very much "either (do it right)...or (risk getting seriously hurt)."
I like all the things you do - it took me two years to stop smoking, fourteen years to start an orderly exercise program, and I still drink 2-3 cups of coffee. Change overnight is not necessary. Even though there are no absolutes, I remain clear in my recommendations. What you feel from me is just this strength and commitment, not to be confused with anger/force/ hostility/demands. The discomfort you feel from my recommended (and not demanded) changes has to do with your resistance to coming out of your "comfort zone." This is not a word game, but if you argue against or don't like the recommendations, it is simply that you wish to hang on to the things that can make problems for you. That is normal enough and part of what we can work on together (by returning for office visits, rather than cancelling).
That the roof doesn't split open and lightning strike the floor in front of you proving the truth of what I say is not really the issue. Do you really doubt the correctness when I encourage (not tell or command) you to choose a very high fiber 10-20% fat, whole foods liv-it (not a die-t) and be trim, muscular, optimistic and realistic, non-smoking and essentially (but not absolutely) non-drinking (coffee/colas/ alcohol)?
As one of those serious types, you may feel I am unfriendly or angry - wrong! My clear words could offer you more support. Being warm, charming, nurturing and maybe a Dale Carnegie "Speak Well - How to Win Friends and Influence People" seminar could put a friendlier aura around me. Can/will you help me with this because the truth always seems to get in the way! Darn it! How about my singing a little song ("I'm Looking Over a 4 Leaf Clover that I overlooked before") or doing a dance to get us both in the party spirit?
Arguing with this is too easy - even I can be a master at arguing against what I say. With this approach, I am honestly only trying to protect you from not just one, but all diseases, an entirely realistic goal. Nobody lives forever, but it is possible to live a normal, very long and healthy life, free of disease, free of depression/anger/high blood pressure/heart disease/diabetes/avoiding the risks for cancer of the breast-colon-uterus-prostate/free of diverticulitis, hiatus hernia and gall stones - mostly through the use of a liv-it, NOT A die-t. We both can and should be patient with each other.
It is not essential to change overnight, nor even in two weeks-years, but it is essential to have the proper attitude as you go about these changes and look to me for guidance and support, seeing absolutely no criticism, only encouragement and leadership.
I hope this clears up the issue; it may not feel nurturing enough, but there is nothing warm or friendly about that list of medical horrors/diseases mentioned above which we can try together to help you avoid. I am just trying to help you live a free-freer, healthy, positive, enjoyable life, staying away from all doctors including me, but not just me by finding a different doctor or by not returning. So, will it be the Galloping Gourmet for me, or will you allow me the privilege and honor of being able to serve you as your doctor and friend? And if things seem a little tense or irritating to you, just ask me to sing my "four leaf clover" song.
H. Robert Silverstein, MD
Hartford, CT