I never thought that my desire to pursue a career in medicine had anything to do with conversations. I wanted to become a doctor for many reasons. If you read A Healthier Wei, you might guess that losing my mother to breast cancer may be a subconscious factor that drove me to become a physician. Other factors include family and cultural expectations as the medical profession is regarded as perhaps the most prestigious of all professions. Never did I realize that my career would really boil down to having conversations—conversations that lead to change.
My medical school, residency, and fellowship training never taught me about the power of “conversations” including those with teachers, colleagues, and most important for a physician, conversations with our patients. I had extensive training since medical school on how to “interview” a patient, which is really asking a series of questions, often like “leading” a witness as we watch on TV law dramas.
Doctors spend years learning to ask a series of questions to get to the answer they are looking for. As physicians continue to experience a high degree of burnout in epidemic proportions, they are expected to see each patient in less than 10-15 minutes, “conversations” are often a luxury that no longer exists. Don’t forget, in that 10-15 minutes, we still have to perform a thorough physical exam, develop a list of “differential diagnosis” or the most likely causes of the patient’s symptoms, what test(s) to order, and what treatment options to suggest.
My training taught me to speak professionally with the patients, but I had never viewed these thousands of office visits as “conversations.” It is my job as the physician to “tell” the patients what would be best for them, and still may be. What has been incredible for me is having experienced my career epiphany: conversations with parents of my pediatric patients, every one of them, have made me a much better physician and surgeon. I have been able to make the absolute recommendations for my patients each and every day BECAUSE I have learned to really listen.
I like to talk, just ask my husband. I remember early on when we were dating, he posed this challenge for me: “What if every person had only a finite number of words given to them for a lifetime, and once they use them up they die…” It made me pause for just about 3 seconds, and then I said, “Well, I would die young but happy.”
A conversation, I have learned, requires active, intentional, generous, and DEEP listening. All the while suppressing your inner voice which already knows what your rebuttal will be before the other person is done speaking. This is very hard—most doctors already know what the patient/families are going to say because no matter what kind of doctor we are, we see patients with similar symptoms every day. A conversation requires almost equal exchange between the two parties involved. A conversation with parents is the most important way I can help influence and increase awareness on the critical importance of diet and dietary habits for children and families. In order for me to share my observations and provide guidance and information on how changes can decrease children’s symptoms caused by the "Milk and Cookie Disease," it requires that first I seek clear understanding of their child’s eating and drinking habits.
I learned to ask more open-ended questions, including “What is the main concern you have in your child that brings you to see me today?” and “What are you seeing as a mother at home and on daily basis that really bothers you?” or “Do you think your child is as healthy as he/she should be?” Once given a chance, parents love to be listened to, even though my appointment slots are 15 minutes and not always designed to foster conversations unless I am fully aware and make them happen. Authentic conversations generally help me understand the main factors impeding a child's health: that a child is allowed to eat lots of sugar, is not raised to eat more fresh fruits and vegetables, drink more water, or live in a household where physical exercise and activity is not made a priority. Conversations with the adult caretakers are what bring forth the truth about parental beliefs or lack of awareness of the impact of dietary habits on health. How we feed our children is based on deeply rooted “stories” we have experienced and now tell ourselves, which either encourage a healthy adult lifestyle and behaviors or not.
Conversations are not just important in my life and my work, but most importantly in our households. Each day, parents have conversations with their children, no matter what age. Are we making the most out of the noises uttered by us during those exchanges? Those conversations can often seem very one-sided orders and instructional as it is at my house: “eat faster,” “put your stuff away,” “can you please do what I asked?” These are really not conversations.
I am learning to have better conversations with my daughter Claire by sitting down and making eye contact, not while multi-tasking. I explain the importance of making good choices about the school lunch menu or why I roasted beets, sweet potato, carrots, and sautéed broccoli for dinner along with couscous on Wednesday night for a healthier dinner. A good conversation with Claire allows her to ask questions and share with me her feelings about that meal, and whether she liked it or not, and how to prepare it. I ask about the eating habits of her friends at school, sharing with her stories I hear from my patient families and the conversations I have as I counsel teenage patients. My best moments with my daughter have always been when we have conversations, and I must have more of them with not only her but with my husband as well.
Why are having conversations so hard? It is because conversations take intention, awareness, time, and effort. In our house, I struggle to have conversations because I am a full-time working surgeon/physician and part-time mom, who cooks, does laundry, picks up dog poop, manages our social calendar, plans our travel, makes lunches, works on my research and work I can’t get done at the hospital, and now shares my book/Facebook/Twitter and my Healthy Kids Movement. I can’t forget to squeeze in exercise and personal hygiene like a daily shower! Having a conversation with my husband is so hard, because it is easier just to only talk about what we need to discuss to get through our daily lives and complete “tasks” of daily living for the three of us. Yet, when I have conversations with Dave, that’s when I truly value him and our marriage.
In order to improve the health of all children, prevent their potential development of chronic diseases like obesity, heart disease, and other inflammation-based illnesses, we need to have conversations, over and over, with as many people as possible. To decrease costs, increase value, and increase the overall outcome for every dollar spent on healthcare in the US, we have to do what's easy and hard—to empower families to change their own eating habits and that of their children, and to get kids off of medications. We need more healthy children with fewer medical “diagnoses," to be on fewer medications, to stop drinking sugary drinks, eating horrible and highly processed foods with too much sugar and other toxins.
I believe that every person can reclaim their health and live in A Healthier Wei, but it requires that we take time and live in the moment. Let’s have conversations that matter. Physicians do not have “time” to have conversations, but it is not about time, it is a mind-set. We must think differently for these challenging times that face us as people and as a society. Have a conversation or two today, with your loved ones, friends, and colleagues, then experience the difference and watch the impact you can make.
Revised from an original blog.