Most patients get mad at me for promoting plantbased

For those questions and discussions on the McDougall program that don’t seem to fit in any other forum.

Moderators: JeffN, f1jim, John McDougall, carolve, Heather McDougall

Re: Most patients get mad at me for promoting plantbased

Postby GeoffreyLevens » Sat Oct 22, 2016 8:25 pm

A doctor friend of mine, cardiologist, told me he used to talk to patients about diet but gave up because as he put it, "Getting someone to change their diet is harder than getting them to change their religion." My experience both as an alt.med practitioner and as a "civilian", pretty well backs that up. If someone asks, I answer what they asked about and try to NOT give them much more than that. If they get curious and ask I am more than ready.

I am not a Bible scholar but this jumps out at me as quite relevant:
Matthew 7:6

Give not that which is holy unto the dogs, neither cast ye your pearls before swine, lest they trample them under their feet, and turn again and rend you.

Bottom line is don't ever give up but also don't waste your energy on those who aren't interested. Instead focus it all on those who are. Help whoever you can and leave the rest. That's my take on it anyway.
GeoffreyLevens
 
Posts: 5871
Joined: Tue Apr 06, 2010 6:52 pm
Location: Paonia, CO

Re: Most patients get mad at me for promoting plantbased

Postby roundcoconut » Sat Oct 22, 2016 9:34 pm

Yeah, I see what you're saying about "don't cast pearls before swine" -- it reminds me of "Don't chase a drunk.".

So, I guess I'd say that when you've gotten, say, three indicators that a person just wants to lie in a puddle of self-pity and victimhood, then it would be safe to refer them to a practitioner who specializes in pharmalogical and surgical interventions to "manage" their condition. Don't be afraid to tell people that managing lifestyle and nutritional problems with drugs isn't something you're focusing your practice on. There are people who DO that kind of thing -- as soon as you can afford to do so, I'd encourage you to "fire" some of your patients who are not going to stay with you as you branch into plant-based medicine.

However, i wouldn't write all patients off!

Have you heard, there's this parable that gets told in buddhist circles (I think it's a tibetan/dalai-lama thing) and it's actually pretty smart:
It says that a smart doctor will not waste his time treating patients who will certainly die, even if treatment is provided. A smart doctor will also not spend time treating patients who will certainly heal -- they will let the healing take place without intervening. The people that a smart doctor WILL treat, is the people who will heal if good treatment is provided, but will die if no treatment is provided.

The upshot is that a smart doctor often cannot know for sure which category a person is in, so they sometimes treat categories one and two simply so they can be sure that they never withhold treatment from someone in Category 3.

Does that make sense?

So,if I were in your shoes, I would do kind of a "three-strikes-and-you're-out", where I give patients the benefit of the doubt, and only give up on those who prove that they love their diseases and their donuts, more than they love getting better.

But people adopt a plant-based diet ALL THE TIME-- why not your patients? It IS possible -- think of the fact that none of us was raised by plant-based no-oil parents, and yet here we are.
User avatar
roundcoconut
 
Posts: 2530
Joined: Mon Dec 22, 2014 11:55 pm

Re: Most patients get mad at me for promoting plantbased

Postby roundcoconut » Sat Oct 22, 2016 10:04 pm

Here's another thought for you!:

My brother's a school teacher, and one smart thing he does is that at the beginning of the school year, he tells his students what qualities will determine the outcome they get on their report card.

He says:
An "A" student does these five things.
A "B" student does these three things, but not those two.
A "C" does one thing, not the other four.
(Y'know, stuff like participating in class discussions, writing well-thought-out and well-researched papers, etc.)

So -- one thing I would do as my standard approach if I were a physician, is I would offer a patient with rheumatoid arthritis, a similar framework:
An RA patient who continues to deteriorate, does these five things (continues eating processed foods; undertakes no behavioral changes; uses pharmacology as their main treatment modality; sets aside little time or energy to heal from their RA)
An RA patient who sees moderate improvements, does these five things: makes dietary changes a priority; takes pain meds as a short-term strategy; etc. (Honestly, I know nothing about any medical conditions whatsoever, which is why you're a doctor, and I'm not).
An RA patient who sees tremendous improvements and gets their disease entirely into remission does these five things: cuts out common nutritional triggers immediately AND undertakes an elimination diet; learns about calorie density to deal with excess body weight, blah blah blah. (Again,I have no frigging idea what I'm talking about.)

But, as a strategy, I think this would be pretty solid, to outline five pathways, from total self-neglect, to full first-priority "I'll do whatever it takes", and having given them five pathways, see which one they are interested in pursuing.

So -- that is how I personally would approach patients with illnesses that are lifestyle-related. And I'd give them a beautiful speech about how what they choose to do is entirely up to them, and there is no judgment in any path. The decisions are entirely theirs, and they are the only ones who bear the consequences of their decisions.

Does that help any??
User avatar
roundcoconut
 
Posts: 2530
Joined: Mon Dec 22, 2014 11:55 pm

Re: Most patients get mad at me for promoting plantbased

Postby StarchHEFP » Tue Oct 25, 2016 3:02 am

roundcoconut wrote:Yeah, I see what you're saying about "don't cast pearls before swine" -- it reminds me of "Don't chase a drunk.".

So, I guess I'd say that when you've gotten, say, three indicators that a person just wants to lie in a puddle of self-pity and victimhood, then it would be safe to refer them to a practitioner who specializes in pharmalogical and surgical interventions to "manage" their condition. Don't be afraid to tell people that managing lifestyle and nutritional problems with drugs isn't something you're focusing your practice on. There are people who DO that kind of thing -- as soon as you can afford to do so, I'd encourage you to "fire" some of your patients who are not going to stay with you as you branch into plant-based medicine.

However, i wouldn't write all patients off!

Have you heard, there's this parable that gets told in buddhist circles (I think it's a tibetan/dalai-lama thing) and it's actually pretty smart:
It says that a smart doctor will not waste his time treating patients who will certainly die, even if treatment is provided. A smart doctor will also not spend time treating patients who will certainly heal -- they will let the healing take place without intervening. The people that a smart doctor WILL treat, is the people who will heal if good treatment is provided, but will die if no treatment is provided.

The upshot is that a smart doctor often cannot know for sure which category a person is in, so they sometimes treat categories one and two simply so they can be sure that they never withhold treatment from someone in Category 3.

Does that make sense?

So,if I were in your shoes, I would do kind of a "three-strikes-and-you're-out", where I give patients the benefit of the doubt, and only give up on those who prove that they love their diseases and their donuts, more than they love getting better.

But people adopt a plant-based diet ALL THE TIME-- why not your patients? It IS possible -- think of the fact that none of us was raised by plant-based no-oil parents, and yet here we are.


Love that parable! Thanks for that, and the advice to keep trying.
StarchHEFP
 
Posts: 1226
Joined: Sun Sep 08, 2013 2:19 pm

Re: Most patients get mad at me for promoting plantbased

Postby StarchHEFP » Tue Oct 25, 2016 3:06 am

roundcoconut wrote:Here's another thought for you!:

My brother's a school teacher, and one smart thing he does is that at the beginning of the school year, he tells his students what qualities will determine the outcome they get on their report card.

He says:
An "A" student does these five things.
A "B" student does these three things, but not those two.
A "C" does one thing, not the other four.
(Y'know, stuff like participating in class discussions, writing well-thought-out and well-researched papers, etc.)

So -- one thing I would do as my standard approach if I were a physician, is I would offer a patient with rheumatoid arthritis, a similar framework:
An RA patient who continues to deteriorate, does these five things (continues eating processed foods; undertakes no behavioral changes; uses pharmacology as their main treatment modality; sets aside little time or energy to heal from their RA)
An RA patient who sees moderate improvements, does these five things: makes dietary changes a priority; takes pain meds as a short-term strategy; etc. (Honestly, I know nothing about any medical conditions whatsoever, which is why you're a doctor, and I'm not).
An RA patient who sees tremendous improvements and gets their disease entirely into remission does these five things: cuts out common nutritional triggers immediately AND undertakes an elimination diet; learns about calorie density to deal with excess body weight, blah blah blah. (Again,I have no frigging idea what I'm talking about.)

But, as a strategy, I think this would be pretty solid, to outline five pathways, from total self-neglect, to full first-priority "I'll do whatever it takes", and having given them five pathways, see which one they are interested in pursuing.

So -- that is how I personally would approach patients with illnesses that are lifestyle-related. And I'd give them a beautiful speech about how what they choose to do is entirely up to them, and there is no judgment in any path. The decisions are entirely theirs, and they are the only ones who bear the consequences of their decisions.

Does that help any??


This helps a lot - giving choices, letting the patient decide. Also letting the patient know actions / consequences.

I learned from some wise doctor recently that in his experience he tells small doable goals at each limited time meeting such as "eat 2 fruits a day" or "eat 2c of veggies a day" - I know plant based docs often ask for perfection - but for those resistant, is it helpful to offer small steps to the path of plant-based?
StarchHEFP
 
Posts: 1226
Joined: Sun Sep 08, 2013 2:19 pm

Re: Most patients get mad at me for promoting plantbased

Postby GeoffreyLevens » Tue Oct 25, 2016 4:30 am

StarchHEFP wrote:
roundcoconut wrote:I know plant based docs often ask for perfection - but for those resistant, is it helpful to offer small steps to the path of plant-based?

I took a training some years ago to be a Health & Wellness Coach. Lot of stuff around how to help people change. One very big ksy is what you just stated, and "small" is as they define it, not anyone else. One trick we were taught was to ask the patient/client what % likelihood they felt they could/would accomplish this particular goal. If the answer was 70% or greater they were good to go. If less than 70%, then almost certainly they would fail and really needed a different, for them easier goal. Small changes in the goal could make a big difference OR changes in their motivation i.e. why do you want to accomplish this. For me it would be to be able to do something like enjoying perfect health etc for someone else it might be to dance at their grandchild's wedding; but every person needs to have driving motivations from inside themselves that THEY find truly compelling and is fairly long term. Goals based on fear (disease, disability, threats from spouse...) may sometimes work short term but almost never for the long haul that is necessary.

This was a core text of the course and really is quite useful and good info

Changing For Good
GeoffreyLevens
 
Posts: 5871
Joined: Tue Apr 06, 2010 6:52 pm
Location: Paonia, CO

Re: Most patients get mad at me for promoting plantbased

Postby greentea » Tue Oct 25, 2016 5:56 am

StarchHEFP wrote:I learned from some wise doctor recently that in his experience he tells small doable goals at each limited time meeting such as "eat 2 fruits a day" or "eat 2c of veggies a day" - I know plant based docs often ask for perfection - but for those resistant, is it helpful to offer small steps to the path of plant-based?

Raymond Cool has a nice writeup on taking Baby steps. http://www.raymondcool.com/classes.html
User avatar
greentea
 
Posts: 1937
Joined: Thu Nov 30, 2006 8:46 pm

Re: Most patients get mad at me for promoting plantbased

Postby C.Alan » Tue Oct 25, 2016 6:01 am

Im not in health care, but i've tried to help friends in similar health as your patient: one of the friends is actually a dermatologist. "won't give up my cheese" he says. Another friend has already undergone bypass surgery and suffered heart attacks; and now has congestive heart failure. I've learned to stop at this point and let them live with their choices. But I'm always willing to steer people to this site and Dr. McDougalls' teachings.
C.Alan
 
Posts: 12
Joined: Fri Feb 12, 2016 5:02 pm
Location: Mass.

Re: Most patients get mad at me for promoting plantbased

Postby -mermaid- » Tue Oct 25, 2016 10:38 am

This is an interesting thread...

I'm reading along, thinking about the issue of people remaining motivated after making small changes in their diet and lifestyle. It makes sense to me that making bigger changes in order to reap bigger results and thus the motivation to continue would be a good way to go. I would not have said that before I read about that argument.

Those of you who have treated/coached individuals, how do/did they do ultimately with implementing SMALL changes vs. bigger, more committed changes in diet and lifestyle? I am very interested, since one day I will want to help others in my own way.
-mermaid-
 

Re: Most patients get mad at me for promoting plantbased

Postby bbq » Tue Oct 25, 2016 11:45 am

Death row nutrition offers some insight into the standard American diet.
http://nutritionfacts.org/video/what-percent-of-americans-lead-healthy-lifestyles/

Death row nutrition. Curious conclusions of last meals
http://foodpsychology.cornell.edu/research/death-row-nutrition-curious-conclusions-last-meals
https://cardifffooddotcom.files.wordpress.com/2014/08/1-s2-0-s0195666312002796-main.pdf
http://www.sciencedirect.com/science/article/pii/S0195666312002796
http://sci-hub.cc/10.1016/j.appet.2012.08.017

I don't mean to be offensive here, maybe we could imagine that some patients might live like someone who's getting hospice care of some sort. Just like those death row inmates, they're already eating as if their lives depended NOTHING on it.

In other words, they're more likely to value however little comfort and pleasure they could get outta eating SOS-laden junk day in and day out.

When someone's life is less than optimistic since the future is grim, we should know what matters most:

Image

Image

They wouldn't like to talk about it but maybe dying prematurely is still better deal when compared to giving up such an important (possibly the only) stress outlet for a miserable life. That's more like a coping mechanism when they're no longer able to keep up with so much stress anymore. (Stress activates our adrenal glands to release cortisol and we could tell what's gonna happen to our appetite afterwards. SOS to the rescue even though SOS could be Killing Me Softly.)

Suggesting solutions to those problems alone won't necessarily help them to break that vicious cycle. They've gotta take a look at their lives from a very different angle before they realize what the deal is. Like what Dr. McDougall mentioned before, the ones who would tend to inflict self harm could very likely be those of us who aren't all that happy about our lives in the first place:

http://youtu.be/Cvf5rf19GhY#t=519

Sometimes it's pretty much like making a sale and we've gotta elicit the values of our potential buyers. Big Pharma and Food Cartel already figured out how to push all the right buttons while record sales could be seen everywhere. We're all equipped with water pistols when WFPB should be all about grassroots movements at the moment, they've got fully-loaded machine guns on their sides and that's why they're pretty much making a killing.

It's always a tough sale when we're the only sales representative from a very unique sales department. And then we've gotta bear in mind that making sales won't result in any kinda profits for the corporation, our customers are the ones who benefit from what they're buying.
bbq
 
Posts: 2168
Joined: Tue May 29, 2012 10:23 am

Re: Most patients get mad at me for promoting plantbased

Postby jeff_t » Tue Oct 25, 2016 1:19 pm

Though this lacks any empirical backing, my observations have led me to believe that the vast majority of people in our culture simply do not want to face the consequences of their actions. We want pills to undo the consequences of many years of poor diet, just like we want pills to undo the consequences of not being able to keep our zippers zipped. And we want it for free.
jeff_t
 
Posts: 53
Joined: Fri Oct 11, 2013 1:42 pm
Location: Oregon, USA

Re: Most patients get mad at me for promoting plantbased

Postby Lesliec1 » Tue Oct 25, 2016 1:52 pm

You have to remember that people have been conditioned their whole lives. In childhood, this person went to the doc, got pills for strep throat and was cured. Several times in the coming years, she got sick, went to the doc, got pills (probably antibiotics) and was cured. She just wants to do the same thing she's always done and so does everyone else. Pills or surgery is what most of us were taught. Too bad "adult diseases" don't work that way.

To me the tragedy is that you have waste your talents when there are people out there unable to find a PB doc.
Lesliec1
 

Re: Most patients get mad at me for promoting plantbased

Postby GeoffreyLevens » Tue Oct 25, 2016 4:17 pm

-mermaid- wrote:Those of you who have treated/coached individuals, how do/did they do ultimately with implementing SMALL changes vs. bigger, more committed changes in diet and lifestyle? I am very interested, since one day I will want to help others in my own way.

Really no way to know in bigger sense since no controls, just each person, one at a time. But it seemed to me that allowing, even forcing them to set a goal rather than me arbitrarily assigning one was much more successful generally. Also, asking that key question about how likely they felt it that they would follow through and accomplish, and then adjusting the goal until they got at minimum 75% likelihood seemed to make a very big difference in follow through.
GeoffreyLevens
 
Posts: 5871
Joined: Tue Apr 06, 2010 6:52 pm
Location: Paonia, CO

Re: Most patients get mad at me for promoting plantbased

Postby roundcoconut » Tue Oct 25, 2016 8:14 pm

Re the suggestion of just asking people to make a couple small, meaningless changes:
I'm firmly in Dr Esselstyn's camp, when it comes to the belief that the most ethical thing to do, is to give a person ALL the information about their condition. And then, let them determine their level of compliance.

The thing about small changes is that they yield small (and unsatisfying) improvements. If I tell a person to just cut back their soda consumption by one can per day, them maybe they drop five pounds over the course of a couple months. Kinda hard to excited about those kinds of results!

When someone knows that they are capable of dropping their full amount of excess weight, or getting entirely into remission for their illness, and that there is a well-laid-out protocol that'll get them there, well THAT seems worthwhile. Now, some people really do love their donuts more than their health, but others just have never been given the correct protocol. They've never had anyone believe in their ability to be completely free of their disease, or of their excess weight, or of their substance abuse (in the case of coffee, cigarettes, whatever). So, i'd really encourage you to BE that, for the people who are willing to pick the path of complete remission and drastic results.

Keep in mind that dozens and dozens of us here, are here because Jeff Novick, and Drs. Fuhrman and McDougall and Goldhamer and Klaper and Esselstyn, GAVE us that path.

I would've been pissed off if all of the above said, "Traci, maybe you can get from 135 to 130, but people aren't really capable of great changes, and you'd be foolish to try to get yourself completely off of oils and fats." No, man. Screw that!

So, baby steps are fine for people who wish to implement great change, one step at a time, but if the entire protocol is, "Just reduce your cola consumption a teeny bit", then you are offering them crappy bits of improvement, when they are capable of so much more.

I'd say, at least OFFER them the path of compelte health. Be sure that they know, "YOU CAN COMPLETELY TURN YOUR HEART DISEASE AROUND" and I can show you how. Be sure that they know, "You can be in complete remission from your joint pain" and I can help you get there. Be sure that they KNOW.

Now, of course, you can't say "complete" remission, because I know that some conditions do not heal 100%, and some joint damage remains in people, and some level of artery blockage is still there after eating SAD for 40 years. But y'know -- do not act like you don't have the tools to help them heal, when you DO!

So, yes, if people choose to do what it takes to heal as completely as possible, they should know that they can take things one change at a time, and turn into a butterfly (so to speak) over the course of many, many months, or they can just clean out their kitchen and learn a new way of living, all at once. But setting the bar low for people is, in my opinion, an act of betrayal.

You are their doctor. It costs you nothing to offer them a full-court-press plan of excellent behavioral health (nutrition, exercise, etc.), and you can ALWAYS feel good about yourself if you present them with five different paths, and they choose a path of only moderate nutritional modifications.

But I believe that people need those who will offer to support them medically if they wish to get into remission, get off their meds, and transform their health. People are LONGING for this (y'know -- SOME people), and for those who are interested, you can really help them to believe that THEY TOO can turn their health around.

Anyways, those are my thoughts! Hope that is of some use. :)
User avatar
roundcoconut
 
Posts: 2530
Joined: Mon Dec 22, 2014 11:55 pm

Re: Most patients get mad at me for promoting plantbased

Postby GeoffreyLevens » Tue Oct 25, 2016 8:25 pm

just asking people to make a couple small, meaningless changes

That is not at all what was suggested. To the person making the changes they are quite big and meaningful and often, once they experience some success they are inspired to go further with a new decision. The size and meaning are relative to their mental/emotional state, not yours or anyone else's'. This is very often a big problem with people "trying to help" i.e. imposing their ideas of perfection and what "MUST" be done on someone else. I have worked with a number of people and after some discussion it became quite clear to them that they were just not ready to make any changes at all as they already had far too much going on in their lives. I can think of 3 people like that off hand and 2 of them later came back and told me they were ready and fully jumped into eating this way. What is the point of pushing someone to set themselves up for failure? In what way does that benefit anyone?

Absolutely give them a full overview of their situation and options and likely results of each but then it is up to them to decide what is important and meaningful to them.
GeoffreyLevens
 
Posts: 5871
Joined: Tue Apr 06, 2010 6:52 pm
Location: Paonia, CO

PreviousNext

Return to The Lounge

Who is online

Users browsing this forum: No registered users and 12 guests



Welcome!

Sign up to receive our regular articles, recipes, and news about upcoming events.