Bill

In the field of psychology there has been that real revolution, involving Martin Seligmann, Mihali Csikszentmihalyi and others.  There was a wonderful article published in the American Psychologist in the year 2000 (which supposedly was the first year of the new century).  In this lead article, Seligman and Csikszentmihalyi noted that during the 20^th Century psychologists focused on neurosis.  We focused on anxiety.  We focused on depression. During the 21^st Century, what if we began to investigate the role played by purpose. What if we became to focus on the role played by Hope. What if we began to look at relationships that nurture.  So, it is interesting that today during this forum, Mark began by reporting some of the tough data. However, during the past hour we have been talking essentially about the positive factors. Mitch, you have addressed the comparable change that is occurring in medicine.  What if physicians talked about purpose with their patients rather than (or in addition to) talking about diabetes?  What if physicians talked about locus of control and changing expectations? This is what you are all describing. Psychologists have identified this as Positive Psychology.  What would “positive medicine” look like?  Perry talks about the Hardiness Index as opposed to the Life Stress Inventory.  These are all interesting points.

Perry

I love the concept of using your clinical encounter time to try to help people generate hope and look forward (identifying their resources.  In the current environment). However, that’s hard to do in a six-minute visit when the patient is having trouble even accessing enough of their medications to keep hyper-tension under control.  We have some significant challenges.  There was a time in our health care history when your primary care encounter could include expressing concern about “what is really bothering you?”  What’s causing this anxiety, high blood pressure, and all of that kind of stuff.  That’s hard to come by these days.  The time isn’t there because payers won’t pay for it.  The employers say: “well you can’t waste time doing nonremunerative functions.”

Bill

I remember a meeting with my physician here in Maine. A few years ago, I had an appointment with her as an 80 year old patient.  We were going through all of the test results about the high this and high that. 2.0 that and more.  At one point I stopped and asked her: “am I doing an OK job? Am I healthy?” She stopped and smiled. “My God, you are very healthy! You are going to live a long life!”  What a difference this made. It allowed me to listen to the rest of the data.  To have a physician that I trust say: “there is a good chance that you are going to live a long life. So, take care of your damned body!”  She didn’t have to say that, but the reframing was very powerful.  So, Mitch, I wish to hell that you also were my physician. The kind of focus that you have is wonderful.  My physician now asks about many things in my life. My writing.  How am I doing having retired from my job as president of a graduate school. She is beginning to ask new questions—I think it is in part because she and I are both growing older.  So, Mitch, I think that she is changing in a way that is similar to what you are talking about.  She is changing how she operates as a family doc.