Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, M.D.
26 December 2001

PEARLS, GLASS BEADS, OR PLAIN OLD ROAD GRAVEL FOR 2002

     When I was in medical school, the young doctors in training were highly competitive. Each one wanted to out do the next one with some astute piece of information that would educate us all.  Our professors encouraged this behavior by awarding the pearl of the day, the week or even the month and this identification was allowed to be applied to the house officer’s name tag for all to know that that person had come up with a pearl.

     An example would be the case of an unfortunate individual who came to the hospital with shingles.  The shingles involved the forehead and the cheek and was quite painful.  As painful as it was, it was not a medical emergency unless it involved the eyeball itself.  Then, herpes keratitis could result in blindness.  Immediate action was necessary if the eyeball was involved.  On this particular occasion, the resident calmly said that there was no danger of involvement of the eye because the person’s nose was not involved.  He had read in various sources and had learned the rule that unless the nose and especially the tip of the nose is involved, shingles does not involve the eyeball and therefore treatment for herpes keratitis of the eyeball is not necessary unless the tip of the nose is involved.  This is a great comfort to the patient and kind of “wow” to the rest of us who did not know that “pearl”.  Thus pearls are little bits of information that are highly insightful and highly impactful.  They are useful little things to know.  By the same token, a glass bead is not quite so useful and  plain old road gravel is something to throw away and don’t remember at all.

     Through the past several years, a number of these columns have dealt with psychological aspects of medicine.  This is because at least 80% of all medical illness in the United States results from mental attitudes, self destructive behavior, misinformation and miscommunication. The following is a summary of the overall message of these columns.

     The first point to make is that your mood is your own.  No one ever makes you mad, makes you happy or causes your grief.  Whatever you feel and however you feel is done by your own choice based upon your values and your interpretation of events.

     As crazy as this sounds if you harken back to a time when you became very angry at what someone else did, studies have shown that only 5% of the time did the person act with malice and in intend to “make you angry”.  Ninety-five percent of the time, the other person acted having no clue as to what you really wanted, not being able to satisfy your need, or competing with a legitimate interest of their own.  Thus, in only one case in 20 is it likely that your anger might be considered  appropriately directed.  Studies have shown that the person that who is  “angry all the time” has a much higher mortality than the person who goes through life with a happy attitude.

     A second pearl is to recognize that your relationships are critical to your life and well- being.  Medical studies have shown that individuals who have satisfying social contacts live longer and healthier lives than those who do not.  Recognize that almost always the relationship with the other person is much more important than any conflict that arises between the two of you.

Another pearl is to recognize that communication is a highly complex act.  The speaker or communicator sends their message not only with their words but with the inflections, the tones and the intensity of the words along with the body language.  Contrary to what almost everyone believes, the meaning of the speakers message is not necessarily what the speaker intends.  The true meaning of the message is the response that the message brings.  Learn that to obtain the response that you would prefer from the other individual, your message needs to be carefully thought out and well delivered.

Studies done at the Mayo Clinic have demonstrated that a pessimistic attitude is associated with a higher mortality and greater discomfort than the person who approaches their problem with an optimistic attitude.  Pessimism and the belief that success will not be yours leads to “ learned helplessness”.  This is what happens when the person stops trying.  Continuing to try, feeling that you are acting on your own and with some hope of success are all associated with greater health and longevity.

     The last pearl to consider has to do with what I sometimes refer to as “the South Dakota attitude”.  It has been my observation since living in South Dakota that individuals will persevere and endeavor and repeat their actions time and time and time again trying to succeed.  While this is commendable and to be highly respected, it needs to be recognized that there are times to recognize the need for change.  “When what you are doing doesn’t work, do anything else but don’t keep doing what you have been doing because you have already shown that doesn’t work”. South Dakotans tend to be a little suspicious of change.  They are more respectful of tried and true methods.  Having been accused of being a dinosaur myself, I carry a healthy respect for tried and true methods but change is the one constant in our lives.  Everything changes and those unwilling to change in a constructive way get left behind loosing out on the benefits of new and better methods.  I highly recommend a book entitled “Who Moved My Cheese?” a recent best seller by Spencer Johnson.  This is a short easy to read book that gives great perspective on how to recognize when you need to change and how to go about it.

In summary, the most important aspects of an individual’s long term health care are:

1. Avoidance of anger as a coping mechanism.
2.  Maintaining an optimistic attitude.
3. Recognize that relationships are important and conflicts with other individuals are rarely as important as the relationship.
4.  Recognize the need to change when the time comes, be respectful of tried and true methods but not afraid to change when what you are doing doesn’t work.
5.  Recognize that the meaning of your message is the response that you get no matter how well intended the message is when it leaves your mouth.  The effectiveness of that message in achieving your desired response depends upon how the other person receives it.

Believe it or not, adoption of the above rules and the extensions that come from them can result in major changes in a person’s health, happiness and longevity.  Happy New Year to All and Best Wishes for a Joyous Healthy 2002.