From time-to-time, our blogs will discuss life’s paths, whether the discussion is about managing a health care practice or mentoring a patient. In today’s era of ‘big data’ it is common to graph associations and relationships that form health status, but under-appreciate the role of external forces and events that created the path to a particular health status.
For example, one dogma I hear a lot is that people are making bad lifestyle choices, and that all that they need to do is follow The Guidelines on eating, exercising, coping with stress and to stop using vices. I hear this view especially from those who think that our health system needs to hold people more ‘accountable’. The most frequently suggested solution is to use contemporary counseling skills, such as motivational interviewing, with a goal of having a patient’s ‘metrics’ (diet or physical activity habits or tobacco use or whatever) match The Guidelines.
Looking at lifestyle that way envisions the patient’s life like a function graph. My college calculus professor - Thomas Banchoff - was one of the best teachers I ever had, and Dr. Banchoff said to our class over and over and over again,
“Paths are more interesting than function graphs”.
He was talking about how mathematical equations, when solved in relation to time, trace a curve through space. He held that watching this tracing proceed through time is far more informative than just looking at the equation’s function graph (or plot). Paths are to function graphs as movies are to still photography - pictures are often stunningly beautiful, but it takes a movie to understand how the picture came to be.
Are lifestyle choices a like function graph, or are they more like a path?
If I’m someone's health mentor, does it matter to me if their choices are more like a function graph or more like a path?
Can one accurately change a person’s life path without knowing something of the experiences (and timing of them) that molded his or her mind?
If a patient’s life is like one of Dr. Banchoff’s function graphs, then all that one needs to do is get them to plug-in the right lifestyle risk variables and their function graph will be solved! But if his or her life is more like a path, then such health risk metrics by themselves are not adequate to help them find a healthier lifestyle path.
Perhaps the most interesting thing about lifestyle medicine is the perspective it provides on a patient’s life, revealing the innate and learned talents he or she has (or doesn’t have), how his or her personality and life experiences influence their actions, and how the world around them - social circles, built and natural environments, family life, capital resources, etc. - affects what the patient does.
Viewed this way, a patient’s lifestyle is not a graph, but a movie with themes and plots that are similar to other patients lives, but each is a unique story that has never been told before. When one looks at the food a patient enters into a diet log, one can see it portrayed as a fixed graphic compared to the USDA food plate and judge whether particular food groups are adequate to meet the guidelines. But, it is highly useful to have a patient’s log, two patients can have identical logs but have achieved them through very different paths. How similarly should these two patients be counseled? Would the same advice and suggestions work equally for both?
Some behavioral theories suggest that life path doesn’t matter that much, while other theories hold that path matters a lot. A debate on that will wait for other blogs, but my own personal bias, being the son of a psychologist and having counseled many patients in clinic, is that both are true and that there is an art to balancing the two. In everyone’s life, years of experiences predispose each of us to favor what we do. In many cases it is important to understand how the patient’s life uniquely molded his or her actions. Viewed that way, lifestyle medicine is infinitely interesting because everyone’s tale is unique, even though the vast majority look very similar - too sedentary, consuming the Standard American Diet and stress that is poorly controlled!
In the future, we will discuss these ideas further, but I hold that Dr. Banchoff was correct:
Paths are more interesting than function graphs.
References (from Professor Banchoff):
Flatland: A Romance of Many Dimensions. Edwin A. Abbott, 1884.
The Annotated Flatland (2002), coauthor Ian Stewart, Perseus, ISNB 0-7382-0541-9