Sunday, May 22, 2016

Self-Efficacy, the Best Medicine

A recent blog post caught our attention and we shared it on our Facebook page (scroll to Thursday, May 19, 2016).  The post was written by Dr. Kory Zimney, PT, DPT for Evidence in Motion and was entitled, Is Your Treatment Needed To Get Patients Well?  The blog post is succinct and very well-written, so I encourage you to check it out even though it's written towards medical providers.

It's a funny thing about the medicine machine these days.  Aside from some very important advancements in communicable disease prevention and trauma/infection care, the machine has failed miserably.  Now you might think that really smart people with a lot of power are working on this issue right now and that they're going to come up with a fail-proof plan of action to guide us all to a brighter future.

Or you're not.

I was talking to a friend about this today as I spent a little time on the foam roller.  Have you ever used the hollow cylinder of hopelessness before?  Perhaps a more accurate description would be to say I was rolling in agony and having a conversation to distract myself from the fact that my quadriceps felt like they were melting from my femurs.  We spent our mobility sessions discussing everything from farming and local farmers markets to running around barefoot to healing from common injuries.  It occurred to me, as it has many times before, that we wouldn't have a healthcare crisis if people were healthy.

I'd always wondered being a child of the 90's and having observed this epidemic of diabetes, obesity, dementia, and other chronic illnesses develop, why aren't people healthy anymore?  I could look at my grandparents and see that their way of life brought more health than in the generations since, although I am not sure I can fully explain why.  They may not necessarily know more about medicine or the science but they were getting better results.

Can I tell you a story?

You might think it's sad, but it's really just a normal Texas childhood.  This is the story of the marriage between nature and nurture, the delicate dance of what you're given before and since birth.  I believe I was given the personality trait of stubbornness.  In a sense mother nature blessed me with a little self-efficacy.  I didn't always follow my own way but I always questioned the way things were and I always knew that my heart was worth fighting for.  My parents also exposed me to certain situations that may not be so acceptable today.  For example, after instruction on how to safely use a rifle, my parents might send my 8-yr old version to the woods alone and strongly suggest I not come back until dinner.  Now long before the days of cell phones (how is it that I thought the idea of a video-phone was so cool in the '90s and now that we have it I could care less?), before I ever imagined face timing another human being, I was clearly left to my own devises.  As children my siblings and I found ourselves in all sorts of conundrums and we were the ones who nearly always fixed it ourselves.  Nearly, my half-sister couldn't fix her own broken arm after we jumped off our backyard tree onto the trampoline and she continued the ride by catapulting 10ft in the air and landing on an outstretched hand.  Once my brother shot me in the leg with a pellet rifle when we were squirrel hunting.  The first thing he said to me was, please don't tell mom!  I never did and she'll never read this blog.  My brother later became a Military Policeman, go figure.

Before I could really earn the privilege to fish with my own rod, I had to show that I could cast it.  So I practiced casting a small fishing weight into a bucket in the backyard, hours at a time.  And when I started running raccoon traplines on the river, I had to show my step-dad that I could tie a proper knot to secure the boat.  When I crashed my bike on a homemade ramp, my father did not fix it for me because he told me not to jump my bike off a ramp.  I fixed my bike as best as I could and ended up with a bike that couldn't turn left (the front brake was bent and caught the wheel, so I could only ride straight or take a right...Zoolander anyone?).  My parents did not check my school work.  If I failed to make a satisfactory grade I was to ask my teacher for extra help.  I wrote all my own papers, I decided to take AP classes and exams, and I chose my own extra-curricular activities.  My parents always made it clear those were my decisions.  When it came time to go to college, I completed all of my own scholarship and school applications, studied for and took my entrance exams, and managed to pay for my own college.  I did the same with graduate school when I commissioned into the US Army.

Historically accurate representation of my childhood ramp skills.

What is important in the story is not how great I was or how hard I worked, it's about what I didn't have.  I didn't have protection from failure, instead, I had to deal with my emotions, learn the lessons, and move on.  Instead of fixing my problems, my parents said, hummm, that sounds like a problem.  You are capable of figuring it out though and you should go work on that.

As a licensed physical therapist having certain credentials, you know the sort of credentials that are supposed to represent knowledge, I try to know my stuff.  It not only seems like the right thing to do, it also seems like the legal thing to do.  I just wouldn't do well in prison, clearly not enough space in the yard for me to train for Leadville.  The problem with medicine and life is, if you aren't okay with being wrong, then you'll never be right.  Many great thinkers have agreed that roughly 50% of what we know is inaccurate and unfortunately we have no idea what 50% this is.  So to get what we say we really want, excellent patient outcomes, we must be emotionally mature enough to admit we were wrong.  Sometimes we have to struggle through problems to find the solution.  Certainly it can be a difficult and uncomfortable process.  I graduated from physical therapy school five years ago and already I have changed my opinions on many of the textbook answers, some have been complete 180's.  But in the end this is what is supposed to happen, we are not our ideas after all.

So what do we need more of in our current healthcare situation?  My short answer is self-efficacy.  Nature taught humans how to live healthy lives, when we were in touch with the earth, when we grew, hunted, gathered, and ate whole foods, when we were out working in the sun and went to bed after dark, and when we weren't hyper-connected to a digital world.  This is how my grandparents and many of your ancestors lived.  It makes perfect sense.  Mother nature vets everything with time.  We aren't all running around with medication deficiencies but if you go to a doctor's office or watch five-minutes of television you might think otherwise.  Instead of being in tune with our bodies, we ask everyone else's opinion about it.  Should I eat this or should I eat that?  Maybe you should eat real food and see how you feel.  Take out what doesn't work for you.  What's my ideal body weight?  What weight do you feel best?  How much sun exposure is healthy? When do you start to sizzle?  What should I do to heal this injury? Have you given it time and the opportunity to heal?  Have you any practice at listening to your body?  Should I take this supplement? Do you have a rare or fatal genetic disorder?  It's your call but a better question might be, what are you lacking that you should be addressing with something that's been around for ages, not something recently manufactured and you have no idea what's in it and the sketchy science supporting it is probably funded by industry (deep breath after that run-on sentence).  What did people do before the supplement?

As time goes on and I spend more of it in the modern industrial medicine complex, I have only one thing to say to the public.  Get closer to nature and minimize all the modern conveniences and mind-numbing time wasters.  Learn to listen to your body again.  I mean, really listen to it.  This is what my grandparents and great-grandparents had to do to survive, there were no other options.  In the end, they not only survived but they have lived long and robust lives.

Imagine a younger version of me in the early 90's riding in the bed of a pickup truck when it was still legal for children to do so.  The wind in my hair, two wide blue eyes scanning the open fields for anything that moved, a coyote or deer maybe.  That may seem like a dangerous practice but there were risk-mitigation strategies.  My parents drove slowly in low traffic areas, undistracted, and the kids knew the rules of how to ride.

The question I have is, how does that compare to parents driving distracted on their phones in traffic with their children buckled in the back seat?  Does the child booster seat and the airbags offer a sense of safety that gets abused?  Does this in some ways parallel how we have treated health as a society, just put it in someone else' hands?  We are such medical geniuses in 2016, of course there is a pill to cover every poor decision I have made.  Having been in both situations, I can attest that leisurely riding on backroads in the bed of a pickup truck is much safer, and not only that, it is a different sort of activity and experience altogether.  Which do you prefer, frantic and distracted driving to a head-on collision or exposing yourself to calculated risks like a slow ride in the open air so you can fully engage your life?  Perhaps my stubborn soul is to blame but I will always prefer the later.

Don't listen to me.  Engage your life, make mistakes, and find out what works for you.  Own it all.

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