The Heart Beat

By James Beckerman, MD, FACC

I’m talking about the media frenzy back in 2009 when President Obama met with Professor Henry Louis Gates and Police Sergeant James Crowley at the White House over beers in the aftermath of Mr. Crowley’s arrest of Mr. Gates at his home.  It was awkward, but President Obama declared its potential as a “teachable moment” for Americans to confront the state of our Union — or lack thereof — with regards to racial issues. But ultimately, this teachable moment was criticized as a lost learning opportunity for multiple reasons – one of which was that in the end, no one seemed willing to say that either party (Gates or Crowley) was truly responsible for what happened.  There was no real accountability.

This got me thinking about what facilitates a successful teachable moment in health care.  We use that phrase quite a bit to describe an interaction between a patient and the medical system in which an intervention (behavioral or medical) is most likely to stick.  This jibes with the popular definition of a teachable moment as described by Robert Havighurst in his 1952 book, Human Development and Education:

“A developmental task is a task which is learned at a specific point and which makes achievement of succeeding tasks possible. When the timing is right, the ability to learn a particular task will be possible. This is referred to as a ‘teachable moment.’ It is important to keep in mind that unless the time is right, learning will not occur.”

One of the most recognized teachable moments in medicine involves the prescription of cholesterol-lowering medication. Studies show that compliance with statins is significantly higher in people prescribed them while in the hospital as compared to in the doctor’s office.  Turns out that a heart attack makes for a pretty captive audience.  We’re pretty good at teaching after the horse is already out of the barn.

But are there teachable moments in prevention? That proves to be much more elusive. But it’s my hope that by dissecting the teachable moment, we might be more likely to create environments in which they can occur. I have identified three components.

The first is Freedom. You need to be in a position to make choices before you can truly change your behavior. You need to live in a safe-enough neighborhood so that you can walk outside. Your kids need decent lunch options at school. You need to have time to be active and to put together a healthy meal. But most of all, you need to be aware that these choices do exist. I feel like we sometimes are in denial that we have choices. It’s true that there are societal, corporate, and even biological obstacles to making sustained changes in behavior, but we shouldn’t constantly use them as crutches. Instead, we should identify opportunities for change and make them more convenient.

The second component of the teachable moment is Accountability. Your choices need to matter.  To you.  To the people who care about you. But what about your employer? Your government? Here’s where it starts to get complicated. We seem to want our infrastructure to care about us (i.e. we want health insurance, and we want appropriate health regulations), but sometimes we don’t want them to care too much, especially when our privacy is involved.  But unless we are held accountable to some extent for the choices we make, our choices seem to matter less.  I want to believe that accountability to ourselves is all we need, but that seems a bit too optimistic.

Finally, there is Responsibility.  When you have freedom, and you are held accountable, something amazing happens. You start making better choices. You assume responsibility, and the best part is that you achieve results.  Responsibility is the key for individuals to make changes.

Think about your own situation. Are there things you’d like to do differently? Remember the choices you have. Remind yourself that you are accountable to yourself, to your family, and maybe to others for those choices. Taking responsibility is one of the unique opportunities you have to make a difference.

Freedom + Accountability = Responsibility.   F+A=R.

All this teaching is making me thirsty.