Michael suggested that it might take the identification of small changes in one’s behavior. He noted that a 5% change in certain health care practices can make a significant difference in life expectancy.  By eating a couple of additional portions of fruit each day or engaging in a little more exercise we can extend our life. We don’t have to do much to become healthier.

Jeremy adds to this suggestion regarding incrementalism. Exercise doesn’t have to be a big thing. Even a brisker walk to the kitchen can be considered exercise.

Bill B. wondered if the incrementalism identified by Don Michael might be appropriately applied in health care practices. He also asked if a bit of technology might be introduced. Could there be a device that provides us with immediate feedback regarding the health-related impact of the 5% change we have made.

Bill G. believes that effective persuasion regarding positive health care practices must go beyond the evidence and beyond strong logical arguments. People need to hear the message being delivered in new ways.

Michael expands the horizon of the forum conversation. He brought up the powerful role played by agri-business as well as pharma in keeping Americans sick and dependent on health care cures. With the loss of farmland, there is a push for agricultural practices which yield higher volume per acre (often with the assistance of added chemicals that are not healthy for humans). Pharma, in turn, benefits from the negative outcomes related to these agricultural practices. We need a broader, more systemic perspective when addressing health care issues. Physicians need to embrace new systems-based mental models.

Bill B suggests that this might mean a uniquely portrayed Agri-Pharma complex (to align with the military-industrial complex first articulated by Dwight Eisenhower in his inauguration of the Industrial College of the National Defense University).

Michael proposes that all is not lost. 1% change in health care habits can make a difference. How can we help our patients make this small change during the 15 minutes we have with them?

Perry notes that this 15-minute recommendation by a physician makes sense. However, physicians make money from sickness not health. Answers are being hidden. Can’t physicians instead follow what Michael has suggested? A cafeteria of health-ensuring practices can be offered by the physician. The patient picks one or two that they can do and that will make a difference.

Bill B. offers an example of the appreciative, positive approach being suggested by Michael and Perry. As a patient, Bill B. has worked with a primary care physician to lose weight. He had an upcoming appointment with this physician—but had not lost any weight. Bill was tempted to cancel this appointment. However, he kept it and when he reported that he had not lost weight, the physician asked a surprising question: “have you gained weight?” I said “no.” She then suggested that we spend a few minutes identifying ways in which I have avoided gaining weight. My physician had “caught my game.” Rather than feeling guilty about not losing weight, I was suddenly challenged to find ways in which I was avoiding the gaining of weight. How could I now use these behaviors to lose weight. This was a very effective reframing engaged through “catching me doing it right!” (an appreciative approach).