Tuesday, February 2, 2016

The Foundation

My mother in law, Pat, lives next door. She's 86 years old and set in her ways. She has her habits, she has her opinions, she has her routine.

She's overweight and has been for as long as I've known her. Pat has had long standing issues with borderline diabetes, syncope, vertigo, high blood pressure and a host of other issues.

And like most in her age bracket, she loves sweets.

LOVES sweets. Donuts, cookies, sweet rolls, candy - pretty much everything and anything that someone near diabetic with attendant complicating symptoms should not eat. But Pat has very little self-control. She likes to shop, and likes to shop for what she likes to eat - food with sugar as its primary ingredient.

Because of her various medical issues, Pat sees doctors often. She has her long standing general practitioner who counsels and warns her about her diet. Her ophthalmologist (cataracts) warns her about her diet. Her dentist warns her about her diet. Specialists, internists, neurologists, and other professionals ... have warned her about her diet.

Last week Pat was referred to a nutritionist by her primary care physician, presumably to provide her with the knowledge and tools necessary to construct and maintain a diet appropriate for a woman with her suite of medical conditions.

And yesterday she consulted with her internist for more counseling about her diabetic state and nutritional admonishment.

Then she went to the grocery store and in her cart my wife found cookies, cinnamon rolls, and cake.

"I'll only have one cookie a day," Pat dissembled actively. "And besides, these were on sale."

Pat loves shopping and loves bargains and, even more, loves buying things particularly when shopping and when a bargain.

She knows this diet is not healthful for her. She knows eating sugar is anathema to her medical condition. She knows that she could cut her pharmaceutical bill by hundreds of dollars a month ... if only she could control her sugar urge (habit).

In the workers' compensation world, Pats various medical issues would be called co-morbidities.

I always thought that was a weird term. Morbid = death. So, if work doesn't kill you, then these other things will!

The payer community doesn't like to pay for someone's death that isn't directly related to work. I get that. I don't like to pay for things I don't cause or use either.

But here's the problem: you can counsel, you can penalize, you can incentivize - but you can not, but for the rarest of examples, change behavior.

And the older one is, the more entrenched behavior becomes.

Because there's a whole host of issues underlying that behavior that nobody has any control over, in the least someone who is not entire psychologically self-aware, or is in denial, or uses that behavior as a control and comfort for an otherwise out of control, uncomfortable life.

Essentially, all of the attempts to alter long term, entrenched behavior that has origins well outside of nearly anyone's understanding, are futile and a waste of time and money.

Pat likes sweets. Sugar is Pat's comfort zone. She knows it's bad for her. She knows it underlies her high blood pressure, her dizziness, her upset stomach.

And she'll continue to consume it in high doses regardless of the risks.

Pat doesn't need to be told that she shouldn't consume sugar, because there's no way to control her outside the examining room.

Rather, Pat should be provided with alternatives. The medical professionals know she craves sweets. They also know that as soon as she's out of the medical office she's in the store buying cookies that she'll claim to consume one per day (but in reality one BOX per day). There are lots of alternatives to refined sugar products: fruit, artificial sweeteners, and other products that would satisfy her carbohydrate conundrum.

Workers' compensation faces these issues daily on a large scale. Co-morbidities: evil health, medical and psychological phenomenon that interfere with return to health, return to work, retrograde of disability.

Trying to change the behavior underlying co-morbidities is futile most of the time, no matter how much we believe it is better for the person, worker or not.

I'm not saying we should just give up trying to ferret out co-morbidities to deal with them in an industrial setting. But we shouldn't obsess over them. Recognize them, understand that likely these won't change, and move on. Make some attempt at correction, but realize when it is ineffective and fruitless.

And then provide some options that are better health options; perhaps not optimal, perhaps not what really should be done, perhaps less than effective - but better than the alternative and within the person's behavior pattern.

You can't teach an old dog new tricks. But you can build upon the foundation.

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