For any practitioner who has attended an Institute for Functional Medicine (IFM) course, you know how overwhelming it can be with all the studies that are reviewed and highlighted during a conference. It's great to have that scientific support, but we still have to remember that studies do not take into account individual differences, and we have to face patients (and colleagues) who criticize the way we provide health care. If its a colleague, I show them the research and tell them about case studies. Patients, however, want the "proof" in other ways.
I had one of these patients earlier this week.
A 44 year old male came to me with the primary concerns of improving his gastroesophageal reflux and overall gut function. He noticed that stress and dietary choices affected these symptoms, but he wanted more evidence (i.e. lab results) that would convince him to make any lifestyle changes. His goal with our visit was not to find a way to eradicate his symptoms (he already knew many of his triggers - stress, processed foods, and alcohol). He wanted to be educated (his words).
"I won't make any changes to my diet unless there's evidence that it's not good for me"
Because of my experience with patients, I see 70% of people improve with dietary and lifestyle changes. I can save patients a lot of money just through this step - no labs required. This patient had already experienced some of the effects of good nutrition and stress relief, and he wasn't asking for a magic pill, but his request got me thinking about "proof" in medicine.
I could tell him about the thousands of patients that get better with habit changes, or the studies that show that certain foods always cause a degree of inflammation in the body. I could also tell him that no lab test is perfect. But nothing I say would convince him. Some practitioners may be thinking about how frustrating this patient is to "question" the experience and wisdom of his health care provider, but to me this encounter was humbling. The patient has a valid concern. Food (and alcohol, in his case) can be one of the many pleasures in life. Why should I take that away from him when I have no concrete "proof" that it will help him?
What I realized is that I can't tell anyone what to do, or convince anyone to do something. The patient has to be inspired in some way, whether that be via:
- Personal motivation (i.e. wanting to eliminate symptoms, prevent an illness that a loved one went through, or being healthier "for" someone else)
- Direct experience with getting better through dietary/lifestyle changes
- Recognition and acknowledgement that health requires active (not passive) involvement (there is no magic pill, but there are "magic" habits)
- Awareness of our current cultural influences that affect our health, of the realities by which we base our lifestyle (i.e. prevalence of unnatural chemicals and pesticides that affect our health over time, the effects of social media and marketing on health/food choices, etc)
At the end of the visit with my patient, we did end up getting a few tests to look into non-Celiac gluten sensitivity and food intolerances. What he does with this information is entirely up to him.
I will not be able to convince my patient to stop eating processed foods and drinking alcohol daily, but I can do my best to inspire and educate him. "Proof" is dependent on the actions of the individual.
Wishing everyone great health, happiness, and a life at ease.
P.S. If you want to listen to a great podcast on inspiring vs convincing, check out this episode from Fed and Fit.