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Social circles have a great impact on our behavior, but doctors are still viewed as authorities
Last Thursday, Vator and HP held their holiday salon gathering, called SplashX Invent Health - Vitality: Lifestyle as a drug, where a group of innovators, adopters and financiers got together to take a deep dive into new innovations and frameworks that could get people to be more proactive about lifestyle behavioral changes, such as exercising more, eating more nutritious food, resting to be mindful, and embracing sleep.
These changes don't often come from physicians, who might give the usual advice: 'Stay active; rest; eat an apple a day, etc." If they can prescribe a medication to stop pain, depression, and some other condition, they'll typically default to doing so, when maybe a person needs more holistic healing that encourages a lifestyle behavioral change. The problem is: most doctors aren't educated in this way. This challenge led to a recurring theme around community and social circles and their impact on behavior. In one of the conversations, it centered around how much influence a doctor had on changing behavior, and if it was their responsibility.
This topic had come up previously during the second panel of the night, which was made up of entrepreneurs in the healthtech space. Panelists included Esther Dyson, Executive Founder at Wellville; Hemalee Patel, Lifestyle Medicine Physician at Crossover Health/Facebook; Munjal Shah, CEO & Co-founder of Health IQ; Seth Serxner, Chief Health Officer and Senior Vice President of Population Health at UnitedHealthcare Optum; Pankaj Vij, Kaiser Lifestyle Medicine, President at American College of Lifestyle Medicine; and Daniel Chao, CEO of Halo Neuroscience. The panel was co-moderated by Archana Dubey, Global Medical Director at HP, and Frances A. Ayalasomayajula, Senior Manager, Worldwide Healthcare at HP.
Chao weighed in by highlighting the significant impact social circles shape our behavior.
"You look at communities today and they drive dietary behavior. In certain communities, it’s the unhealthy choice that is the default behavior, so it’s hard to be the only one around other people that are behaving differently. I live in San Francisco and everything’s organic, everything’s whole fresh fruits and then I’m the parent that’s bringing a Snickers bar, handing it out to kids and I’m the bad guy and that’s good. There’s social policing around me and now I behave because it's, ‘Hey, Dan, you shouldn’t be giving those things out.’ That’s awesome, but the reverse is true in other neighborhoods where those types of practices aren’t happening. I go back to, what is the psychology or the neuroscience behind decision making? At some point, it’s like resisting temptation, at some point you just break. There’s only so much a mind can handle, you can’t be contrarian for that long and you just break," he said.
He discussed a neuroscience skill called cognitive control, which is "our ability to control our thoughts, to do the things we want to do, to resist temptation."
"I would argue that, today, the temptation to do other things that are off topic is as high as it’s ever been in humanity, and it’s because of this thing that sits in our pocket constantly. That is pushing us to the limit such that maybe by the middle of the day or the end of the day you just have no more cognitive control. You’re short-tempered, you make worse decisions. Like, ‘I’ll have the burger, forget it, it’s been a day.’ But half that problem was self inflicted because you’ve been messing around on your phone for too long. To bring it full circle with children and community, I just read in the New York Times, what are the most high tech cities doing with devices and children? They’re taking them away. Paradoxically, they’re like, ‘Chalkboards, no iPads.’ And yet, in more disadvantaged neighborhoods, it’s like, ‘Let’s shower them with electronic devices.’ Now, the future will tell which is the right approach, jury’s still out. If I were a betting man, and I am, I would bet that the approach of going analog with children is the right approach. But time will tell."
HealthIQ's Shah essentially agreed.
"If you look at how most of us have learned our healthy habits and things, nine times out of 10, if I ask you, ‘Where did you first hear that?’ you’ll saying, ‘This friend of mine who’s really into health,'" he said.
"It’s not a perfect system but it seems to be a way that we absorb information around health easier and better than a formal authority figure relationship. When we ask a lot of our users at Health IQ, ‘Where’d you learn that?’ so much of the time they find what I call a ‘supernode.’ There’s somebody in their friend circle who is the health nerd, who reads everything, who does everything, and at cocktails parties now, as you get older, as I enter my 40s, you talk about three topics: school, real estate and health. Then, as you go to your 50s, from what I understand, it’s half the time health. It increases and increases and increases. This is how information is passed, why aren’t we building infrastructure to pass information this way?"
As much as community can influence our decision-making, though, there was agreement that there's been a lot of burden put on physicians as well, to be health literate and to get people to change their lifestyle. This was brought up by Vij in an answer to a question from Ayalasomayajula about how doctors talk to each other about the way medicine is changing.
The doctor's behavior and role
"In our organization, we’re looking at joy and meaning in medicine. Having that joy and meaning comes from doing something that’s actually impactful and meaningful. This stuff that we’re talking about is tremendously impactful and very, very meaningful. Some people sneer and snicker but, below the surface, they also know that this is the only way that we can really make an impact on the community, on people that we serve and ourselves too," he said.
"We’ve been skirting the question of motivation for behavior change and one of the biggest drivers of that is the behavior of the person giving that advice. So, if you’re talking to a doctor who’s a cyclist, he’s probably going to talk about exercise, the exercise that he’ll talk about is cycling. If it’s someone who’s a mountain climber, he’s going to talk about mountain climbing. If he doesn’t do anything, or she, they’re unlikely to talk about lifestyle."
Patel responded that there's a lot of "misinformation out there," which she sees in her own patients, so the doctor is responsible for giving out better advice.
"If I could pay myself the amount of times that a patient comes in and is like, ‘Well, Dr. Oz was talking about garcinia kombucha as a weight loss supplement,’ and I’m like, ‘That’s not even a thing. You want your heart to speed up then go snort cocaine. You’re coming to me for actual advice.’ I agree that physicians don’t know everything and I think that’s why it’s great to see clinicians pushing lifestyle medicine, because there’s a responsibility to learn about this because your patients still trust you at the end of the way. You’re still that trusted person to dispense that advice, it doesn’t matter what your friend is doing and how good they look and what kind of plastic surgery they got to get that and now are saying they’re drinking the best green tea they’ve ever found. You’re responsible as a provider and that’s not going to change any time soon," she said.
"Unfortunately, or fortunately, clinicians are still the authority and patients are coming to them for that affirmation, confirmation, etc, and we are responsible to push it along."
Dubey agreed, saying, "I agree with that and I do believe that the model of delivery of health literacy is now being put on the shoulders of the healthcare provider because the information has exploded to massive levels."
Dyson spoke next, and talked about the burden that is being placed on doctors now, mentioning time she spent at the Michigan Academy of Family Practitioners, where she saw just how much information a doctor was expected to bring into the room with them for each patient.
"On one of the display tables there was a pile of 25 sheets of paper stapled together, 50 pages, each page was something that you should do during the patient encounter. Some only for teenagers and some only for old people but the clinician cannot fit that all in. It’s just not workable. That’s why they feel overloaded," she said.
"The solution is called 'The other 45.' The doctor meets with the patient for 15 minutes, maybe talked for 8 and types for 8, and then afterwards there’s a resident there. The patient goes with the resident and the resident says, ‘Did you understand what the doctor said?’ And the patient says, ‘Well, not really.’ Does this advice make sense? Can you afford the medicine? Do you know where to buy the food? And spends 45 minutes connecting the doctor’s advice with the patient’s reality."
"I absolutely agree with that. In the Future of Clinics, we talked about models in which the provider or the clinician, whether it’s in the form of a nurse or RN or whoever, can be extended out of the health center. Because what happens is what you get in that limited 10 minutes of typing is not what truly sticks when they go out and they’re still in the wild west. How do we get the patient to the best version of themselves?" said Dubey.
"There’s a lot of health literacy that takes them there and there’s a lot of assumption of risk that needs to take them there. What is happening is we are pushing the responsibility of health and well being to the wrong places and the healthcare provider has been locked down in the room, typing. The highest paid typist you’ll get in the whole world is the healthcare provider when they should be going out and truly helping people to understand the health literacy. And they can extend themselves and actually do a better job of it than him going on Dr. Google or Dr. Oz and getting the wrong advice."
Vator CEO Bambi Francisco spoke up from the audience, bringing the conversation back to what Shah said about community, which she believed is a big influencer on our behavior if not the No. 1 influencer. "Our behavior predominantly comes from our upbringing, our family and our social circles. It's up to us to teach our children how to be mindful, and to eat more nutritious food and how this will keep them healthy. At the same time, a lot of people do look to doctors as the authority. So we need more doctors to understand lifestyle treatments as the prescription. We need more lifestyle medication doctors."
Physicians want that lifestyle education, said Patel, and they don’t like it when patients come to them and they don’t know what good nutrition is.
"I remember going to my own doctor when I was 16, because I was a very chubby tomboy, and I was like, ‘Why don’t I look like my sister or my brother?’ because they were very slim. He was like, ‘Well, pile on whatever you want on your plate and just eat 20 percent of that.’ That’s not nutrition. In my head I was like, ‘Cool, I can pile on 1,000 donuts and just 20 percent and I’m good.’ And that’s literally my thinking at the time which made me really interested in nutrition, because that’s not the way. Unfortunately, medical education doesn’t really spend enough time in learning about and teaching physicians about nutrition, so physicians want an area to actually learn to be able about this. Physicians who are practicing lifestyle medicine should really push this forward in a scientific way," she said.
Vij responded that doctors should step up to the table and get that education to impart it back to the patients.
"The biggest disservice that modern medicine has done since the discovery of penicillin is to dissociate ourselves from lifestyle, from food. You can be discharged from the hospital for just about any condition and ask, ‘What about my food? What should I be eating?’ and it’s, ‘I don’t know, just take this medicine. That’s all I was taught.’ So, for us to get back into that conversation and take back the authority that we earned, we have the credentials, we need to have the expertise to back it up."
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