The American College of Osteopathic Family Physicians sponsored event, “No One Likes to be Yelled At” with Meridith Norris, DO, took place on Tuesday, August 7th at 12pm on the UNE Biddeford Campus. Dr. Norris is the current president of the Maine Osteopathic Association (MOA) and practices at Graceful Recovery in Kennebunk, ME. Her talk focused on the importance of relationships in treating patients. Empowerment, self-efficacy and trust are basic pre-requisites that patients need in order to be a participant in their own health and wellness. By recognizing some of their own biases and privileges, physicians can help cultivate a positive reframing of the way patients think about their own health and possibly overcome some hurdles that has kept them from achieving their own personal aspirations.
Dr. Norris started out by addressing the inherent challenges in what we do as physicians: we often show up too late to help the people we are supposed to treat. Patients arrive at the doctor’s office asking to be “fixed,” and often the idea of fixed comes in a pre-packaged, easy remedy that will cure them (i.e. a Z-Pack for a sore throat). Many diseases, however, are the result of a sedentary lifestyle, which can be for the most part preventable, but are in no way an easy fix. The challenge for the physician is that by this time patients have already been yelled at, or lectured on their lifestyle. Implying that their disease is their fault isn’t helpful and ultimately won’t help the patient get better.
For example, Dr. Norris stated that the quality of life scores are worse for obese children than for children undergoing chemotherapy due to the stigma and
internalized shame that comes with obesity. Dr. Norris argued that attaching morality to obesity is a misattribution; it implies that if you are obese then you are doing something wrong, and if you are thin you are doing something right. There are a number of factors and circumstances and therefore it is not necessarily accurate or helpful in perpetuating the bias. You don’t know what their behaviors are until you have established some sort of relationship where the patient is willing to share their experience, and extrapolate on some of the challenges they are facing. An adverse childhood event study assigned one point for each negative factor that children experienced during childhood (i.e. trauma, poverty, illness, etc.). The higher the points, the more likely the child would develop long-term chronic health problems as an adult. What the study emphasized was that you can’t always control what happens to you. These negative experiences create a lack of self-efficacy that makes it difficult to sustain adverse reactions to stimuli. As a physician, you may have a very different experience than many of the patients you see, and it is important to recognize your own biases based on your own privilege. Dr. Norris states, “Just because we can do the things we can does not mean our patients can.”
In order to treat your patients, you have to treat them like a person. You will be more impactful by treating patients with respect and dignity than by lecturing them on what they are doing wrong. Patients need to be empowered in order to build skills of self-efficacy. Motivational interviewing is one method for physicians to check in with the patient to see where they are at. Dialoguing with the patient in this way
FINDING YOUR MAGIC: NO ONE LIKES TO BE YELLED AT
Meridith Norris, DO speaks to physician-patient relationships