Scared Healthy

Fear can be a great motivator, but using fear in a medical practice requires some discretion. For years, we have some great anti-smoker posters in our office – people with black and missing teeth, lip tumors, etc. The non-smokers liked them; the smokers, not so much. Smokers, although will not usually admit it, are expecting a cancer diagnosis just about any day.

On WebMD’s Ear, Nose, and Throat board, I will get a posting of someone worried about a lump in their neck. If they also mention that they are a smoker (but, trying to stop), I can easily guess at their underlying fear, namely, the Big C. As simple and repetitive as this advise has become, giving up cigarettes is a lot easier than living with the fear of an occult tumor forming somewhere.

There is nothing like a physical examination to get someone’s attention. When I come in to the room, I can pretty much determine if someone is a smoker. How? Smokers smell like cigarettes; their breath, their hair, and their clothing. Sometimes, you can see a pack sticking out of purse or pocket. So, in order to have a more "teachable moment", I don’t really say anything about it….that is, until I listen to their lungs.

I will spend a longer time listening; asking them to take a deep breath, or cough, and then listening some more. I feel their necks and armpit areas for enlarged lymph nodes. I try and get that very concerned, sort-of-worried look on my face

“I suspect you are a smoker. How many packs a day do you smoke?”

“Why? What are you hearing? What are you looking for? I now have their complete attention – the Teachable Moment.

"It is quite obvious by listening to your lungs and examining you that you are a smoker. Can you tell me why you are continuing to smoke in light of the fact that it is going to kill you some day? I want you to stop smoking….TODAY!"

ENT specialists see a lot of people with persistent sore throat. As you might expect, the smokers are thinking "throat cancer". Any ENT that misses this excellent opportunity to motivate people (with a little healthy fear) to stop smoking is not doing their job.

"Do I have throat cancer?"

"Not yet, but I do see evidence of tissue changes that can be early signs of smoking related disease. You have to stop smoking…Today. Or, otherwise I may have to give you some very bad news someday."

In the last nine years or so, I have limited my practice to children and adolescents – young people that are often more willing to change their behaviors than adults. Of course, parents of teenagers may differ on that opinion. Medical professionals do seem to have more of an impact on behavioral changes than parents, sometimes. Children, especially teens, can readily tune out parents when it comes to advice.

The importance of good nutrition should always be addressed on well examinations.

"Do you have any concerns about your child’s nutrition?"

"Why, yes. He refuses to eat any vegetables or fruit." A sly grin appears on the mouth of the 8 year old sitting on the table.

"That’s okay. He doesn’t need to really eat those things anymore. (I have HIS attention). We have some great vegetable and fruit shots. You will need to bring him in twice a week. Bring someone to help hold him because those shots a somewhat painful….we have to put them in the corner of his EYES!"

"Shots in my eyes! No way, Mom. I’ll start eating vegetables and fruit. Tonight!"

Okay. We’ll give you another week or so to see if you will eat them. Your mother can just call me and I will make the arrangements for those injections if you don’t.

Yes, it was a bit tricky, but there are really no rules when it comes to getting kids to do the right thing. I am not happy about scaring them healthy, but you do what you have to do in this unhealthy world.

Studies have proven that kids who refuse to eat, say, green beans, have to really eat them TEN TIMES in order not to be repulsed by them. They first have to tolerate them on their plates. Then, they have to be able to pick them up; touch them. Next, they need to smell them and put one to their lips without gagging. The next step is to get them to eat just one, tiny piece; a microscopic amount. They can wash it down quickly with water or juice if they want. The final steps involve eating just one green bean; then two, then three, etc., to the point where they have been tortured with about ten Bean Encounters. Most children should be able to eat them without complaining (too much) after this time.

Many years ago, I did a physical exam on a man that had so many health problems that he frightened ME. He was about a hundred pound or more overweight, had uncontrolled diabetes, hypertension, arthritis, smoked, drank, had a sedentary job (security guard), ate poorly – lots of salt and sugar, and hasn't exercised since high school. He had a strong family history of heart disease. He was a walking time-bomb and didn’t seem the least bit concerned. So, I sent him a registered letter. The letter listed his serious health problems and my recommendations.

I didn't hear from him for nearly a month. I felt that I must have insulted him with that letter. One day, I got a phone call from him.

He said the Good News was that he was ready to make some serious health care changes. The Bad News was that he was calling from the Coronary Care Unit having survived his first (and hopefully, last) heart attack. There is nothing like being on a heart monitor, tubes coming out of every orifice, oxygen, etc. that sort of scares you into being healthy. It is really too bad that it took a heart attack to (finally) get his attention.