While reading some online content the other day, I happened across a paragraph that gave me pause. The article was addressing the work of primary care providers. Nothing earth shaking in what I read until I saw a sentence that said we should ask the patient how they define health. WOW!!! This is a major point that we often overlook. Taking notice of this one item can explain a great deal about our patient’s health behavior.
Those of us who have chosen an occupation in the health and wellness field have been well educated in the classic definition of health. We study normal lab values, charts, tables and a plethora of other items that we use to define good health. Variations to these normal values are usually indicative of some disease process. When a healthcare provider sees a value outside of the normal, we have this deep, burning desire to manage and correct the process that produced the offending value. We will often consult fellow practitioners to get their consul on how to best address the problem that we have found. Then we use a variety of medications and procedures to try and bring all of the values we measure back to the physiologic normal. At that point we pronounce the patient healthy.
According to the Centers for Disease Control and Prevention, there are approximately 12 million workers in the healthcare sector. That seems like a lot of people until you consider the population of the entire United States, slightly more than 300 million people. Thus, only about 4% of the population looks at health the way that a nurse, pharmacist, physician or other healthcare worker does. The other 96% probably define good health or wellness in ways that we find difficult to comprehend.
When a healthcare worker sees a patient who is diabetic, they will usually pronounce their management as being good when associated with either a fasting blood sugar between 70 to 120 mg/dl or a hemoglobin A1c of 6 or 7%. We have all read studies, viewed slides and listened to lectures that tell us that these values are indicative of good health. But what about the patient? How do they define good health in their own mind? The variety of answers will truly astound many people, but it will explain a lot of unhealthy behavior.
Most people usually seek medical care for one of two reasons. Either they are in pain or they are leaking a red, warm, sticky fluid from their body. Otherwise, they will pronounce themselves healthy. It is easy to see how this applies to those who have not been sick previously. But many people, even in the face of a diagnosed chronic disease, will consider themselves healthy if they subjectively feel good. Never mind the dire warning of future consequences if they don’t take their prescribed medication. They feel good right now, so they must be ok. Unfortunately, this is when the patient decides to abandon their medication or other treatment. You see, by their definition, they are now well again.
It is important for us to determine how the patient defines good health. In order to gain their compliance in helping with their treatment plan, we need to know how the patient views what we are doing for them. Some people are inquisitive and will seek out knowledge about their disease process from us or other healthcare sources. Others are not interested in our dire predictions about increased risk of stroke, heart attack or other serious event if they don’t take their medication. They are living in the here and now. Tomorrow is another day that will be addressed when it arrives. Once we determine the patient’s definition of good health, we now have some insight into how we need to approach them. It may mean that this patient will benefit from a support group or more frequent follow up visits. It may mean that they will actually read and utilize the patient education pamphlets we give them.
Whatever the situation is, we must take the time to get the patient’s idea of good health. If we ignore this critical point, we may constantly wonder why the patient is not getting any better in spite of all of the advice and medication we may dispense. Working towards a common goal with a common definition will probably make life better for everyone.