Journal of Participatory Medicine: How a Patient Was Motivated by Reading His Office Notes

February 29, 2016

Author’s Note: This is an entirely true story (I actually referred to my office notes as I wrote it), with only the patient’s name changed.

I saw Joe (not his real name), a 63 year-old retired corporate manager, for his annual wellness visit. Joe has been my patient for 20 years. He has always been overweight, and only once did we make headway in changing his lifestyle and helping him to lose a bit of weight, but this was short-lived. And it was not for want of trying. I tried many different approaches and prescribed specific dietary and exercise interventions. But he never seemed fully committed to changing his diet or to exercising. It didn’t help that many people he knew, including his wife, were overweight—we know that obesity is contagious in social circles. He also had a mostly sedentary job, another risk factor.

He inexorably gained weight over the years, about 30 pounds in all. Along with the extra weight, he also accrued other medical problems. At his first visit he complained of longstanding heartburn. I made a diagnosis of gastroesophageal reflux, which we managed with lifestyle changes and antacids. Later, he developed hyperlipidemia (high level of “bad cholesterol”) which eventually required treatment with a statin. His blood pressure rose. He developed sciatica, which worsened with time (and weight gain). He developed osteoarthritis. Throughout all this time, he remained unwilling to undertake important lifestyle changes (or even to take small steps), despite my exhortations that it would really help him feel better and require less medication.

When I saw Joe at his wellness visit (and to assess his now chronic conditions, including obesity), he was miserable. He told me that his brother had recently died of a heart attack. He complained that he had chest pain when he swallowed, and was taking a large amount of antacids. He had general achiness (wondering if it was from the statin he had been taking for years) and mild diffuse joint pain. His arthritis and sciatica were worse. And he was even having problems with his libido.
On examination we found his weight was higher as was his blood pressure. The rest of his examination was unremarkable.

Read Danny Sands’s full article here.