It seems to me that taking care of yourself is a b...

2012-01-17T15:29:52.124-06:00

It seems to me that taking care of yourself is a behavior. MDs and nurses are not generally known for their skills at behavior modification. Health professionals generally "examine," "evaluate," and then "tell" the (presumably uninformed) "patient" (what sociologists called a sanctioned role) what to do. DsM companies seem to have elevated this old-world office practice to what I have heard called "Nurse Nag," and on a massive scale. Whether or not the nagging comes sooner or later, or is facilitated On-Line, or the "examining" and "telling" happens remotely through gee-wiz devices and briefly amusing games, it's still nagging. It can feel insulting, and frequently as an invasion.

Modifying behavior begins with empathic listening. Health care professionals would do themselves a favor by shadowing a good Employee Assistance counselor for a month to see how this is done.

Also, it is hard to focus on diet, exercise, nutrition, or compliance with a drug regimen, when you are going through a divorce, your kid is in jail, you or your spouse has an addiction, all your close friends and siblings live recklessly, or you think you might get laid off. I listened in on a DsM call several years ago and heard a diabetic tell a nurse that he was depressed and profoundly demoralized by his illness and his life situation. He was told something to this effect: "Sounds tough. But it is really important for you to take your insulin. I will check on you next week." Click. This was then promptly registered in the DsM company's database as an "engagement."

I am not surprised that we are ambivalent about disease management or skeptical of its efficacy and its metrics. These types of "protocols" are at best meaningless interactions and at worse degrading intrusions. Outbound calls like this are as likely to produce, say, insulin compliance, as mere chance. At their worst, these practices are iatrogenic.

The good apples in the DsM barrel have learned how to listen rather than talk, and connect with people's lives before they connect with their biology or authoritatively expound on what needs to be done.

DsM is an industry that doesn't listen well. It just wants to tell, and spends a lot of time (and money!) inventing new invasion routes. A lot of people who could benefit from it hang up, or BS personal information just to get off the call. We can all do better. I suggest we can start by listening.

Keith Dixon
President
Magellan Behavioral Health

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It seems to me that taking care of yourself is a b...