Amy Givler, MD

For most of my life I’ve made one New Year’s Resolution on the first of January.  The important word, there, is “one”.  If I make more than one I can’t seem to stay focused.  So I make one.

Having a New Year’s Resolution means I can focus on one bad habit to break, or one good habit to train myself to do.  One year when I was in my 20’s I resolved to wear a seatbelt whenever I was in a car.  One year in my 30’s I resolved to read through the Bible in a year.  Last year I resolved to do some sort of brain-challenging puzzle every day. 

Every year, the first week of January I have to stay focused and ever conscious of what I’ve resolved.  The second week it comes a bit more naturally, and before too long I’ve made it a habit, a habit I’ve usually carried on into future years.  If I skip a day or a week, I don’t beat myself up.  The point is trying to incorporate one improvement into my life every year.

I know most people who make New Year’s Resolutions don’t keep them for more than a few days.  I’ve had my share of those. To increase my chance of success, I’ve developed some criteria for a New Year’s Resolution:

• It must be specific. (NOT, “I’ll walk every day”, BUT “Five days a week I’ll walk briskly for at least 20 minutes”)
• It must be able to be measured in some way.  (NOT, “I’ll eat more healthily”, BUT “I’ll eat five servings of fruits or vegetables every day”)
• It must only depend on me to do it.  (NOT, “I’ll improve my relationship with my kids”,  BUT “I’ll initiate a conversation about a non-controversial subject with each child every day” — or “week”, depending on whether the kids are living at home)

Some bad habits are difficult to break.  These require extra measures of planning and extra measures of grace if (or when) they prove resistant.  Tobacco, for instance, is highly addictive, which people often only realize the first time they try to quit.  Some people can go from smoking two packs a day to zero, but they are the exception.  When my patients tell me they can stop anytime, I say, “Prove it.”  Generally they come back saying, “I didn’t know it would be so hard.”  So a New Year’s Resolution could look something like, “I’ll cut back my daily cigarettes by one each week, and stop completely on April 1st”.

You’ll notice I haven’t mentioned the most common New Year’s Resolution of all — which is also the most commonly broken.  “I’m going to lose weight” doesn’t meet two of my criteria.  It’s vague and it’s unmeasurable.  So I’ve never made losing weight my New Year’s Resolution. 

Never, that is, until today, the first day of 2009.

I’m 50 now, and extra pounds are creeping onto my aging body, and my body is protesting.  I haven’t acquired them rapidly, so the best way to shed them is slowly.  So here’s how I’ve made my New Year’s Resolution fit my criteria:

1. The first day of each month I weigh myself. 
2. By the first day of the next month I must weigh one pound less.

You see, I know myself too well to just say “I will lose 12 pounds this year.”  If I lose three pounds in the first month, I’ll take myself off the hook until April.  This way, I have only one pound to lose each month — and my weight loss needs to stay on a downward trend.

I’ll let you know how it goes.

I’ve been thinking about what I said in my last post — that I wish the fictional protagonist of The White Tiger were my patient.  Aravind Adiga’s writing is so vivid, Balram seems like a real person to me. The book is a glimpse into his yearning for a better life, and, as I wrote before, his choosing to “break out of the cage” of his old life by hurting other people. Maybe that was the only choice available to him — he certainly seemed to think so. But I wonder. And that’s why I wish he was my patient.

But all day I’ve been thinking about that wish. If he were my patient, what on earth would I say to him?

I would certainly do a lot of listening. He is a person with few social ties — isolated and rootless. The path he chose out of poverty meant severing himself from his past. Social ties are important for health. Having emotional connections with others is associated with healthier lives. And he had no connection with God. I would certainly point him to God.

His goal in life was money and the power that comes with it. But there’s a spiritual side to people that can’t be ignored — at least not forever. Jesus Christ came to fill the deepest parts of people’s spirits. I would love Balram to meet Him.

I read a lot. The characters in most books generally fade into the background of my memory. The protagonist of The White Tiger, by Aravind Adiga, however, won’t be fading anytime soon. He is an self-made man in India, an entrepreneur who rises from poverty. But this is no Horatio Alger story, with a hard-working, morally upright protagonist. No, this protagonist, Balram, chooses the only path he sees available to him to leave his grinding poverty behind — and it’s a path that involves hurting others.

Now the logical thing would be for me to say that I disliked the book. But I didn’t. And I say this even though it’s an earthy book — not quite graphic, but earthy. Early on, I knew this character Balram, and I experienced what he was experiencing. He is absorbed with life, and with his quest for freedom from the chains of servanthood, and I became absorbed with his quest. I wanted to talk with him, to reason with him to choose a path that didn’t involve hurting other humans. I liked him and figured there must be another path available to him. I wish he was one of my patients.

Of course, my perspective is that of a woman of privilege who has always had a variety of choices before me. That is what poverty strips a person of — choices.

When I was a much younger doctor I became frustrated with my patients who hadn’t bought the prescriptions I had prescribed. Or, those who had bought it but hadn’t taken it regularly. Or maybe they were still smoking, or not yet exercising, or still eating too many fatty foods. Now I ask many questions, and try to avoid frustration completely. I don’t know what living this person’s life is like. Maybe they have done all they can do to get to the appointment that day. Maybe their life is so chaotic that it’s going to take several visits for them to understand the danger of their medical condition. Maybe they didn’t understand what I was telling them last visit and I need to slow down and explain it again, and this time more carefully.

Maybe they haven’t had the opportunity to make many choices in their life.  To move toward health is a choice. It’s a choice that even the poor, whether they realize it or not, do have available before them.

A friend recently asked me how she could better connect to her children’s doctor. She has three young children and sees their doctor regularly but doesn’t think his temperament fits their family. She’s thinking of changing doctors, but wonders whether she should just try harder to relate to her current one.

I told her I group doctors into two categories — those who want to make all the medical decisions, and those who don’t. Of course there’s a range, and all doctors fall somewhere on the spectrum between seeing themselves as the dispenser of medical wisdom and wanting patients to make their own decisions for their care. I fall squarely in the middle. I see myself and my patients as members of a team. I know some things (knowledge about diseases and medicines, etc.), they know some things (what’s worked for them in the past, what side effects are tolerable, etc.), and together we figure out how to move forward and maximize their health.

My friend’s doctor is far over on the “I’ll make the decisions” scale. He doesn’t explain things well and she gets frustrated. I suspect she’ll be happier with someone who listens more, and seeks out her input into her children’s health.