A Fine Line

Truthfully, I’d rather write about a fine wine than a fine line, but I need a new wine experience first and most of us walk a fine line or two every day. So here we are.

Any attempt to find balance means not veering too far either direction from the intention we set, goal we hope to accomplish, or plan we agree to follow. This is especially true when it comes to healthy habits.

Some lines can be wider than others.

Most of us have been taught we need to work out 3 or more days a week for a minimum of 150 minutes total to gain the health benefits of working out. A recently published study shows that schedule doesn’t need to be so rigid. Working out 150 minutes in one or two sessions is just as effective as breaking up and spreading out the workouts.

That doesn’t mean elite athletes would gain the same performance enhancement from such a change in schedule. Their line may be much narrower.

People with a history of documented heart disease may need to follow a more restrictive diet than someone who is generally healthy and has heart disease in their family. For the generally healthy, regular workouts and a Mediterranean diet that includes chili peppers at least 4 times a week may be sufficient to reduce the risk of possible cardiovascular events.

Those with allergies to shellfish risk anaphylaxis if they do not strictly avoid shellfish. Those with histamine intolerance may suffer allergylike symptoms if they eat shellfish, but without an accompanying allergy, they do not risk anaphylaxis.

Allergies and intolerances are both best treated by avoidance. But the risks may not be equal. This means finding the healthiest line can be complicated and confusing. And a healthcare system that focuses on time management at the expense of patient communication exacerbates the problem.

How do you know what line to toe?

For many of us, it will take a lengthy journey of medical visits, research, trial, and error to figure that out. We hope our posts bring new insight that speeds the process. As knowledge evolves, the line you toe will evolve.

I wish that weren’t the case. I know you don’t need another job. I know the effort it takes to avoid COVID and monkeypox may already be sapping your energy.

I also know that living with less pain, inflammation, fatigue, and anxiety will go a long way toward making up for the time you invest in finding your healthiest path. The problem is staying motivated through the slogging.

Here are a few things that help me. I’m a pretty tough general with myself. And I like to feel a sense of accomplishment. But mostly, I can turn anything into an experiment that amuses me, teaches me something, or satisfies my curiosity.

Years ago, I conducted random surveys. They weren’t for anything scientific or even writing related. I was curious and I wanted to know how people would respond. For a period of time, I asked women in bars whether baldness made men less attractive. I kept the results on a ripped corner of legal pad paper folded into a pocket in my purse. There were plenty of occasions to pull out that survey and reassure some balding man he was not losing his charm.

Self-assessment can be done the same way. Record how you feel when you walk vs swim vs lift weights. Your survey questions can be constructed around whatever motivates you – do I feel stronger, skinnier, sexier, more energetic, more focused, etc. after I walk or swim? Do I feel more comfortable wearing short sleeves when I don’t eat corn (or whatever food may be giving you an itchy rash)?

Surveys may not be your thing. Perhaps challenging yourself to create new food combinations is more appealing. Or maybe finding a way to prepare your family’s favorites using no dairy without them knowing it amuses you. The point is to motivate yourself while determining the fine line that will leave you feeling your best.

Once you find the main path, updates are faster and easier. And once you feel better because of toeing the line, you may find you prefer adherence. I like feeling better!

If feeling better doesn’t feel good, there’s a whole other line to explore. But not today. I’ll leave you with that while I find some fine wine!

Adherence vs Compliance

Is adherence better than compliance? I recently saw a doctor tweet a list of words he hates to read in patient charts. One of those words was compliant. He indicated adherent was superior, always. I’ve been thinking about that in light of the difficulty many of us have in complying with medical advice – including specialized diets.

I know, it may seem like semantics. But maybe in this case semantics matter. And I think this doctor makes an important point.

To get the greatest benefit from medical advice, patients need to adhere to plans developed by their medical team and agreed to by them. But I’ve most often heard this described as compliance, not adherence.

Why does this distinction matter?

In the strictest definitional sense, compliance means acquiescing or yielding, especially in a weak or subservient way. I don’t want to feel weak or subservient when it comes to decisions about my health. I’m pretty sure no one does.

I strongly believe in patient-centered care. In such a system, the patient is a valued part of their medical team. I’m not sure you can feel valued as part of the team when are related to by medical professionals as though you are, or should be, weak and subservient.

And let’s be honest, many times there’s pressure from medical professionals for patients and families to behave in a subservient way. If they do not, they may receive dismissive or condescending treatment. When this happens, it seems predictable that patients will tire of such treatment and rebel.

If a doctor talks down to, bristles at questions, fails to explain, or refuses to listen to patients, that physician is not going to be as likely to get a buy-in on a prescribed health plan. If that professional perceives there is pushback and relies on a position of superiority to attempt to enforce compliance, the patient will rebel even more.

And why not?

Our lower brains may perceive this kind of pressure as danger. When that happens, the patient must try to somehow twist their being into compliance while feeling they could be in danger. And the feeling of danger is exacerbated by a constant barrage of advertising pushing medications and health screenings.

Essentially, we’re asking people to do something very difficult to do. Intellect may not intercept the lower brains signals on a conscious level leaving behavior to be guided by survival instinct or reflex. Of course this won’t be true in every case. But it may be true often enough that we could improve adherence just by changing our rhetoric.

Adhering connotes steady devotion, allegiance, and attachment. In other words, if I choose to adhere to something, I embrace it. That sounds like the relationship I want when it comes to my health. I hope to embrace a plan that I perceive as the healthiest for me in any given moment.

Adherence places the patient back in a position of power in charge of their health. It is willingly given and does not require pushing at all.

Why not change our approach to seek adherence? When we treat patients in a manner that encourages them to embrace a plan, there will be no need for pushing, cajoling, shaming, or arm twisting them into compliance.

Could such a subtle shift make a difference?

There’s no way to really know until we try it. But if one physician has recognized the benefit, I’m guessing there are others. And if we as patients push for this change, we may get more palatable healthcare.

I feel like eating plans tailored to the needs of an individual and presented respectfully will make many dietary recommendations less objectionable and easier to embrace. That will take us a long way toward adherence.

Some may determine that adherence vs compliance is a bit potayto, potahto. I disagree. I feel like a shift toward adherence is just the shift we need.