If the purpose of your professional life is to induce the induction, management and sustainability of health and vitality, not simply the absence of disease, you must first look in, and then project out.
The establishing of a core set of principles that shape, and in part define who you are will be determined by various intersecting influencers, life related experiences and the learnt or inherited ability to critically review and appropriately contextualise these values.
Once propagated and set on a path of evolution there is an inevitable temptation to transpose these personal experiences onto the person seeking your guidance.
Of course, many of the core elements linked to functional and lifestyle medicine are immutably transferable, but are they the primary point of mutual agreement? By which I mean does the deterministic element of knowledge transfer (perceived or real) overlay reflect that needed by the recipient, when in many cases listening to their story and then retelling it allows far more effectively for a mutual path to be elucidated.
For while primary prevention is a desirable aim, people attending your consultation room are often not adequately motivated by the possibility of future pain (physical or emotional), which in part accounts for why lifestyle as ‘medicine’ has not been willingly embraced across multiple disciplines.
Albeit that is slowly changing as the landscape of the 20th and 21st centuries have seen big changes in the nature and prevalence of disease. The shift, as you are only too aware has been from a predominance of infectious diseases to a predominance of non-communicable, chronic diseases; a cross-over now accepted as an almost inevitable ‘rite of passage’ in advanced and increasingly in emerging market economies.
However, individuals are motivated by present pain or loss of function, and a growing body of evidence is showing lifestyle interventions to be efficacious for the management and, in some instances, treatment and reversal of chronic conditions – that is, for secondary prevention.
So, the dialogue between yourself and the recipient is of course predicated on the idea of a shared decision making, yet as you know many seeking help are lost, unable to find a way forward, for a multiplicity of social, personal, economic, educational and psychological reasons. For every rational motivated person that presents the majority of the others are in a state of seeking – by which I mean they need a path, a route with milestones not so far apart as to be unrealisable and a guide, a mentor and a supporter – as changes they undertake are rarely in isolation from their peers and family.
One way to drive this process forward is through the power of narrative or story – except in this case it is a rewriting of their story in the context of time and ending at where they are today. To understand and make sense of the world, humans tend to structure the stream of time and events into a story with a beginning, middle, and end. History represents the desire for not only a true and reliable report of events, but also a way to understand the present as an outcome of the past. Every individual has a personal and family life story that entwines in their health presentation.
Your retelling of this story with a structural time line – a short health biography allows the recipient to ‘hear’ the antecedents’ triggers and mediators in the journey, presenting them with the capability to recognise where strategic decisions or events have provided opportunity for intervention.
This process has the power to make the shared decision to change have meaning because they have now seen themselves present within the context of a story – their own! Your skill is to add insights, place relevance on points of intervention, negotiate a mutual aim and in doing so bring order to their often-chaotic perception of illness.
Practice the delivery of narrative, metaphor and nuance, never underestimate the power of hearing your own hard to understand health needs being chronologically explored and intellectually explained within the context of care and transfer of power to the recipient.