It's not the easiest thing to come to see the doctor. Many patients have told me that it scares them because they feel as if I will add a medication that may further complicate their lives. Instead of writing a prescription, I ask "What would you like to do to make yourself healthier?" I can't count the number of faces that look surprised once I ask this question.
Although sometimes people think that doctors know best, I believe that the collaboration between doctors and patients works even better. I found that not prescribing medications and instead developing a health goal together actually works. Besides, deep inside of all of us is our own inner kid that does not want to be told what to do.
So let's take losing weight.
I like to look into what my patients are eating. The first step is writing down the foods that they eat. Then that's when our brains get to work. We both look at the current diet and then make a plan together on what can be changed. We both discuss an appropriate goal together and work from there. At the end of the appointment with me, my patients know that they are the key in reaching their goal. My job is to encourage, give them ideas on what to do, and hold them accountable.
Now, let's talk about high blood pressure.
High blood pressure is known as the secret killer. It can sneak up on you to cause strokes, heart disease, and kidney issues. If the blood pressure is not life-threatening and close to being normal, I begin asking what we need to do to treat it. If someone says they do not want to be prescribed a medication and rather make changes in their lifestyle, I support it. I do not see the use of prescribing a medicine to someone who won't take it.
So I give my patients some time to get things on track. We would again come up with a plan together to figure out what would work best. In these cases, I also suggest for patients to take their own blood pressures at home. Believe it or not, the blood pressures taken at home or outside the doctor's office can actually be more accurate. However, if after trying lifestyle modifications we get to a point where a medication is needed, I definitely suggest it.
Why I Chose this Approach.
The question you may be asking is why have I chosen this approach. Shared decision making has been found to be more effective in my personal practice of medicine as well as in research studies. Personally, I would rather have my own doctor work with me than to tell me what to do. I try to be the kind of doctor who I would like to care for me.
Health is a team effort. My job as a primary care doctor is not to tell you what to do, but to guide my patients in making good healthy lifestyle decisions. Of course, if there are things that may need serious attention and can be life threatening, I will be more direct and strongly suggest certain things. However, majority of the patients I see in the clinic are not at this point. Creating a unique plan with each of my patients is enjoyable to me. It's amazing and fun to see people reach their health goals!
I urge everyone who reads this to try shared decision making with your own medical provider. After all, you are the MVP and our job as your providers is to be your coach who helps you reach your goals.