Posted by: notdeaddinosaur | April 8, 2008

Connecting by Analogy

I had an extremely satisfying patient encounter several weeks ago, during which I was able to translate my medical recommendations into an analogous situation that the patient was able to grasp quickly and completely. By finding just the right approach to explain the concept of optimizing control of cardiovascular risk factors, the patient emerged with an “Aha!” moment and I with the warm fuzzies of a job well done.

The patient was a computer guy in his early 40’s with controlled blood pressure, non-smoker, non-diabetic but with a positive family history of premature coronary artery disease and an LDL cholesterol in the 140’s despite ideal body weight and optimal diet and exercise regimen. He didn’t mind the meds he was taking for his BP but was leery of side effects that he feared from adding a cholesterol-lowering drug. My first reaction upon seeing his lipid panel and hearing his reticence was to let it go. His HDL was decent (over 40) and his BP was well controlled; but something made me pursue the conversation.

“Look,” I began, “If you really don’t want to take another pill, that’s ok. Your cholesterol isn’t that terrible, so I don’t feel that strongly about it either way; but hear me out.

“I’m talking about optimizing your health by fine-tuning all your risk factors, so instead of just being ‘ok’ they’re the best they can be.

“Say I have a computer here, and you notice it could use some updates; maybe some security or other maintenance stuff that — even though it’s working well enough for my needs right now — would fine-tune it, enhance its performance even if I don’t notice anything actually wrong with it; perhaps head off some trouble up the road. I’m sure you see machines like that every day.”

He nodded.

“Now, what if my response to your offer was, ‘No way! Every time someone screws with my computer they mess it up. It’s working fine; just leave it alone!’ I’m sure you meet people like that all the time.”

He looked like a man in a V8 commercial who had just slapped himself upside the head.

“You’re right! I completely get it,” he said. “I’m just being stupid.”

I hastened to reassure him there was no stupidity involved. Just as he had a greater understanding of the capability of a computer and the advantages of preventive maintenance — along with the experience of dealing with stubborn people who didn’t have that knowledge yet refused to trust in his — he realized that I knew more about the body and how it worked, and that he could trust my recommendations. The suggestion of a low-dose statin took on the same significance as loading anti-viral software; in the event of a problem, the drug can be stopped, just as the program can be uninstalled.

He left with a prescription for a small dose of a generic statin, a follow-up appointment for blood work in 2-3 months, and the same warm glow as I over the connection we had made.

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