Archive for the ‘7 Habits Of Highly Effective Patients’ Category

Habit 3: First Things First

You have to take care of your biological needs first. This includes a good diet plus basic vitamins and supplements. It also includes good sleep, ideally 7-8 hours of quality sleep every night and blood pressure in the normal range. Hormones like thyroid, estrogen, testosterone, and blood sugar, cholesterol, triglycerides, iron, and B12 are important. To be ideally healthy you have to be physically fit. “First be a good animal.”

According to Ken Cooper (aerobics) this requires a minimum of 30 minutes of vigorous physical activity three times per week for cardiovascular health. To help with depression or to control weight you need to exercise 6-7 days per week. The effort level required is equal to a brisk walk (2 miles in 30 minutes).

A lot of my patients say, “I hate to exercise.” That’s okay. Don’t call it exercise. Call it work. Vigorously vacuum, mop and clean house, or wash the car – an effort that gets your heart rate up to at least 120 to 144. Or you can call it play. Go dancing, play basketball.

But whatever you do make sure to get off your butt and get fit. It’s a lot easier when you find something that you enjoy doing and for many people it’s easier to do with a friend or loved one. One of the easiest ways to stay fit is to have a treadmill, elliptical trainer, or stationery bike in front of a TV where you can exercise while watching the news, sports, or a favorite show. Don’t put it off – you have to do it!

One thing I do is keep a log of my workouts in my day timer. I convert all exercise to miles and I keep a weekly total and an ongoing total. By running competitively at least once or twice a year I keep myself motivated to work out even on days that I don’t feel like it. To feel good and to be optimally productive you have to be fit! You have to take care of your body, and the most important part of your body is your brain!

Being physically healthy obviously means not smoking – that includes second hand smoke. It means not drinking excessively or abusing drugs or medication. It means being smart and wearing your seat belt.

Although not as essential as physical fitness, a good sex life enhances quality of life. Since stress inhibits sex drive and can interfere with sexual functioning and since we live in a high stress world, a lot of people have a sex life that they are not completely happy with. Thankfully we now have many effective treatments for sexual problems and you need to be able to discuss this openly with your doctor. I will discuss all the specifics of sexual dysfunction in men and women and all the current treatments in a future article.

In addition to your physical well being you have to address your spiritual, emotional, and intellectual needs.

What’s next? Your basic biological needs are being met and you are not in any acute danger. Should we focus more on love (relationships) or work (productivity)?

Actually you can go either way. By focusing on education, training, and work you become independent and self sufficient. That enables you to be in relationships interdependently. You are not needy and you are not manipulative. There is give and take. You can focus on relationships first, especially if you had a healthy family and had “good enough” nurturing. This means you feel good about yourself and your uniqueness. Having a lot of emotional/social support can make it easier to build your career and become self sufficient. Most people alternate between these two major needs.

Stephen Covey describes these levels in Maslow’s hierarchy as “to live, to love, and to learn.” The highest level then is “to leave a legacy,” or what he now refers to as the 8th habit – “find your voice and help others to find theirs.” Your deepest most personal, most passionate driving force or motivation is somewhere inside of you. You may or may not know what it is – you may need help in being able to understand what it is or how you can fulfill it. For me, writing this is expressing my voice and if I can help one person to find theirs my life will have meaning. Find your voice!

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Habit 2: Begin With the End in Mind

Before deciding on a course of action think about your goals – especially long term. 

Hopefully you want to live a long, productive and meaningful life. You want to balance career and relationships, work and recreation. You don’t want to be “okay”, you want to be the best you can be.

In Man’s Search for Meaning, Viktor Frankl describes his philosophy and approach to treatment of mental health problems. He speaks not only as a psychiatrist but as a survivor of years in a Nazi concentration camp during WWII. One exercise he recommends is to imagine yourself on your death bed. Who is there with you? From the vantage point of the end of your life look back and ask yourself, “do I have any major regrets?”


Most of us have some regrets. If we had it to do over again we would make some different choices. Obviously we can’t change the past but we can change the past that hasn’t happened yet. On your death bed will you be happy with the choices you’re making today?

Stephen Covey admonishes us to be careful what mountain we climb. We don’t want to struggle to the top only to realize we climbed the wrong mountain. There won’t be many people on their death bed saying, “I wish I hadn’t spent so much energy taking care of my physical and mental health.” There won’t be a lot of regrets like, “I wish I hadn’t taken that medication that helped me feel better and live a fuller life.”

To some extent we all have a life script. (Steiner) Somewhere in our intuitive mind we have a basic game plan. In some ways it’s as though we are actors in a play. We have to follow the script.

For healthy individuals the outcome is a happy one with lots of “lieben und arbeiten”, (love and work, Freud) Unfortunately for many it’s more like “I’ll be relatively successful but never really happy.” For a few the outcome is some form of tragedy.

One problem with our script is that we write it in the context of our early life experiences before we are smart enough to know what’s going on. Sometimes our life script is going along fine when some kind of tragedy beyond our control impacts us or a loved one and dramatically alters our script.

Fortunately scripts can be rewritten. Do you need to rewrite yours? How do you know? If you are making a lot of bad choices you are probably going the wrong direction. Change starts with awareness.

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Habit 1: Be Proactive

  • Take responsibility for your health and well-being.
  • Develop good health habits and a lifestyle that fosters vitality and fulfillment.
  • Continually educate yourself about health issues and research advances through reading, internet, discussions, etc.
  • And find a good doctor!

What does it mean to find a good doctor?

Find a physician that you feel good rapport with and that you have confidence in.  You need to feel like you can comfortably discuss any health related issues with your doctor. You need to trust that your confidentiality will be respected. You should feel a mutual respectfulness that your concerns and needs and time are just as important as your physician’s. You get the feeling that your doctor genuinely cares about your well being. You are confident that your doctor keeps current and you should appreciate that your physician has confidence in their knowledge and skills, but is not arrogant.

A good doctor admits there are a lot of things we don’t know and every patient is unique and no treatment works for everyone. A good doctor is open to a variety of approaches and welcomes your questions or information that you bring in – not just about yourself but general information like an article you read about a new study. A good doctor doesn’t get defensive. You never feel that any of your concerns are discounted.

So what if you don’t have this kind of relationship with your doctor? It may be that by being open and honest with them you can gradually build this ideal partnership. So for example, you might say, “Doctor, I sometimes feel rushed – that I don’t have enough time to discuss all of my concerns with you.”   Your physician may say, “I’m sorry, take whatever time you need. My patients understand that I frequently run late because I’m willing to give my patients extra time when they need it.” Or they may say, “I’m sorry but we only have 15-20 minutes scheduled and I really need to stay on time today – but let’s reschedule as soon as possible so that we can address all your questions,” or there may be other considerate responses.

But if the doctor got annoyed or defensive such as “I’m behind, there are other patients to see and besides your insurance doesn’t pay well and you already got your money’s worth.” Or, “you have me confused with somebody who cares.” I hope it goes without saying – unless your doctor is just having a bad day you need to find another doctor.

Your relationship with your primary physician is so important that you have to make the time and take the trouble to find the right doctor for you. Ask your friends, ask your pharmacist, ask other health care professionals, but keep looking until you are satisfied. Your primary physician may be a family doctor, internist, OB-gyn, psychiatrist, or other specialist. If you need more than one doctor you can frequently get a referral from your primary physician and increase your chances. Although preferable, it is not essential that you feel as comfortable with every physician you see – as long as you can check things out with your primary physician.

In order to have complete confidence in your physician, you have to believe that they are thorough. My patients usually see my clinical assistant before they see me and they always fill out forms and symptom checklists. I also require that they check in with us at least every six months (3 months if they are on any controlled substances like stimulants or benzodiazepines). Sometimes we do “med checks” by phone. Every patient has to be seen in the office for a more comprehensive review of their status and treatment at least once a year, even if they are doing well – which fortunately most of my patients are. For new patients and patients not doing well, follow-ups are more frequent and are determined according to each individual situation.

There are a lot of good doctors that don’t use clinical assistants or don’t use many (or any) forms, and that’s fine. But, it will require more time with them to cover everything that needs to be covered.

Change starts with awareness. You can’t fix a problem you don’t know you have. A comprehensive evaluation is essential.

Certain problems like lung cancer and colon cancer have to be diagnosed before they cause symptoms or “you are toast!” So, you have a lot of headaches but Advil takes care of them, “it must be stress.” But what if it’s because you have high blood pressure. The Advil is not protecting your arteries (kidneys, heart, brain). The first symptom of heart disease in a significant percent of cases is sudden death. “Oops!” You are tired a lot, your concentration is not very good – maybe it’s ADHD. But what if it is sleep apnea? Eventually sleep apnea raises blood pressure and may cause a significantly shorter life span if not treated.

You have to have a complete evaluation before treating symptoms. Borrow some forceps if necessary, but get your head out of your sigmoid colon.

Being proactive means thinking about and preferably writing down your medical history and family history (at least to include all 1st degree relatives, parents, siblings, and children). Include all medical and psychiatric disorders. Also include any history of recreational drug use, especially any bad reactions you had.


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