* * Anonymous Doc

Wednesday, March 30, 2011

Patient comes in, high blood pressure, BMI of 47.

"I don't know why I keep gaining weight."

"You need to exercise and eat better."

"I don't have time to exercise."

"What hours do you work?"

"8:00 until 11."

"Fifteen hours is a long day."

"No, not 11 at night. 7 until 11 in the morning. I work the breakfast shift."

"And what do you do the rest of the day?"

"I sit on the couch and watch TV."

"All day?"

"I'm lazy."

"And you're wondering why you're gaining weight?"

"This is what I've always done."

"And now it's catching up to you. You definitely have time to exercise. You need to exercise."

"How about starting this summer?"

"How about starting today?"

"I don't want to."

"I don't have a lot of answers for you if you're not willing to try exercising and eating right."

"Diets don't work."

"But we can try and find a plan that can work specifically for you. It needs to start with more movement though. You can't sit on the couch watching TV for 12 hours a day."

"I go to bed by 9."

"Okay, for ten hours a day."

"I'm old."

"You're 39. That's not old."

"It feels old."

"It feels old because you sit on the couch all day, and you weigh almost 300 pounds."

"What if I make it a New Years Resolution?"

"For next year? It's only March!"

"That'll give me time to used to the idea."

"You need to start changing things now."

"I don't want to."

"Then there's not a lot that I can do."

"I told my friends you wouldn't do anything."

"What did you expect me to do?"

"I don't know. Nothing. Doctors are useless."

"What would you like me to do for you?"

"You tell me."

"I don't have any answers if you're not willing to change your lifestyle."

"I'll think about it."

"Okay, at least that's a start."


  1. motivational interviewing. otherwise, you'll beat your head against the wall like this.

  2. i read this aloud to my roommate. we laughed...a lot.

    I'm SO glad i'm going to be PA in 5 months.

  3. seriously??!!?? Sometimes I wish it were legal just to take patients by the shoulders and shake them!!

  4. i had a pt. tell me once that "her" fried chicken was healthy b/c she deep fried it in olive oil as opposed to vegetable oil..she said it was the "good" oil so its not unhealthy to use a pot full of it and she got a discount at Costco for the tub size..

  5. Motivational interviewing sounds great... but it's just too many skills to ask of a doctor! Can you prescribe motivational interviewing to someone?

  6. Low Carb Diet.

    Seriously. Prescribe him to go eat a rack of ribs and that is all (dry rub only, please...)

    Read up on it, doc. Start prescribing it. Gary Taubes has a great book on it...look it up...