Fish of the day

One of the key aspects of wellness is control — not how much of it one cedes to doctors, drugs or lab tests, but how much one retains as a patient.

Having been a patient, a relative of a patient and a doctor of patients, I have had the privilege of seeing this issue of control from multiple sides. As a doc, it is tempting to keep maximum control: to see patients as a series of lab tests, for numbers to be adjusted up and down.  I sometimes catch myself focusing on a person’s “A1C” number if they have diabetes, or their “LDL” if they have high cholesterol, even before I’ve fully got to know their side of the story.

But I remind myself to stop and consider:  Does my patient have trouble reading the glucometer for a sugar measurement? Have I provided them with guidance on nutrition? Have we developed a shared plan for their health and well-being, rather than simply “getting the numbers down”?

In other words, have I helped my patient to gain control of their medical issues (not necessarily their numbers)?

In college, my best friend and I would joke about carpe diem (Latin for “seize the day”) as meaning “fish of the day.” (Carp, get it?)  I think this concept has some really important applications in medicine.  If my patient is not seizing the day — working toward better health, recognizing ways to prevent illness — then we (he and I, and our U.S. health system) are going to remain trapped in a cycle of “sick care.”

Folks come to me all the time for sick care, and some of that is exactly what is expected: a bout of the flu, a fall off a bike, a skin infection.

But aren’t all these “sick visits” preventable, if we seize the day?  Couldn’t I have made sure my patient got her flu shot on time (or better yet, made sure she knew the flu shot was important, and got called when our vaccines were in)?  How about talking with my 7-year-old patient and her dad about the importance of wearing bike helmets? Or empowering our neighbors to advocate for a safe bike lane in their neighborhoods?

But surely we can’t prevent skin infections? Turns out, we may be able to.  In the last few years, communities around the country have seen alarming increases in resistant staph — also known as MRSA — which happen in a normal, non-hospital setting. Our colleagues in public health tell us this may be linked to overuse and inappropriate use of antibiotics.  Smarter antibiotic use can mean less resistance and fewer “superbugs.”

Hmmm… it turns out I have to work pretty hard to think of a true sick-care visit that couldn’t be prevented.  I guess my patients and I have to work harder on seizing the day, and becoming partners in prevention and wellness.

Or, failing that, at least trying the fish of the day. It’s good for your cholesterol, you know.