I have known some of my patients for years and years. I am no longer just their doctor and they are no longer just my patients. We have gotten to know each other. For example, when one of my patients explained that her mother was coming in from out of town, she didn't have to add that she was headed into a week of binge eating, skipping her regular exercise, and then into a month of guilt and feeling badly about herself. I already knew. I also know that when tax season approaches, another of my patients, who works as an accountant, will forget all of his medications. Yet another patient travels six months out of the year, and I know that if she doesn't have her medication at every stop along her route, she will be calling me to tell me she forgot them.
My patients aren't unusually negligent. They are just people, and like all people, they find excuses to lapse in their good health behaviors, they get busy and forget things, and they aren't always perfectly organized. Sometimes I wish I could put all of my patients in a room to meet each other, so they could share their common issues and exchange advice and learn from each other and most importantly, realize that they aren't the only ones who don't always act in their own best interest.
However, there are a million reasons, including legal ones, that I can't do this. Instead, I've been thinking a lot lately about how I can help my patients -- and my readers -- become more accountable. Because here's the thing: Unless you are accountable, you will never really change your bad habits. This is the truth. If you are not accountable, you will always have an excuse, and when you have an excuse, your positive changes will be spotty, inconsistent, or temporary. And that's not helping you.
I have a patient I've known for 10 years, and every time she comes into my office, I ask her the same question: "Have you started exercising yet?" Every time, she answers in exactly the same way: "Almost!"
For 10 years she has been preparing to begin exercise, and for 10 years after contemplating, ruminating and perseverating over the impending exercise, she is still paralyzed by her intentions. She is not alone. So many of us are paralyzed by our thoughts of taking care of ourselves. We don't think we have time. We don't think we are as important as all those other things on our to-do list. Many times, we simply don't know where to begin or how to begin. Perhaps we feel overwhelmed and it's easier to say, "I'll deal with this tomorrow." Whether it is starting a new diet program or beginning to exercise, we get stuck in the same old patterns of stagnation.
But it doesn't have to be like this. Some people do change. Some people do break their bad habits and pick up better ones. However, this requires an action plan, and more -- it requires taking responsibility for implementing that plan, one step at a time. Otherwise, you action plan may be a 10-year concept in the making.
When I tell my patients they just have to start, and be accountable, they often look at me helplessly. "But how?" Of course, I have an answer for this one: your Heart Book.
I talked about a Heart Book in my book, Dr. Suzanne Steinbaum's Heart Book: Every Woman's Guide to a Heart Healthy Life, but in case you haven't read my book yet, your Heart Book is your journal in which you document everything about your day. It is a personal accounting of your life: what you eat, how much, the context surrounding your food choices, and what goes on throughout your day to create the life you've decided to live. It is the story of you, in all its fascinating minutiae. It isn't just a food journal. It is an analysis, a journalist's approach at figuring out who you are today so you know exactly what you need to change to get to where you want to be. You are the investigative reporter digging for your own intentions, finding where you've gone astray, so you can put yourself back on track.
I like to suggest my patients start out by finding a bound book or notebook they love. Of course, you can also do this on your computer or smart phone. Then, begin by asking questions of yourself, as if you were interviewing you¸in an attempt to uncover your own story. Here are some questions you might ask, and then answer in your Heart Book:
- What time did you wake up today?
- How did you sleep?
- How did you feel when you woke up?
- When did you eat breakfast? Lunch? Dinner?
- What did you eat, and how much?
- How did you feel after you ate?
- Did you have any snacks? Why did you feel you needed them?
- Did you exercise today? If so, what did you do?
- If you didn't exercise today, why didn't you? Did you plan not to exercise, or did something interfere with your plan?
- What was the best thing that happened to you today?
- What was the worst thing that happened to you today?
- When did you go to bed? How did you feel as your day ended?
At first, this may seem not so helpful, or even selfish. Why are you obsessing so much over every single thing you do? But as you get into this habit, I promise you will begin to see patterns -- you will see why you made the choices you made. You will see why you didn't do what you intended, as well as why you did do what you intended. You will recognize that before that stressful meeting, you always crave a double-chocolate-crunch-anything. You will recognize that on the days when you argue with your mother or work late or your child has an event, you always skip the gym. You will realize what sets you off, and what calms you down. Most importantly, this kind of journaling will help you to recognize at a deeper level that you really are responsible for the kind of life you live. Your life is a direct result of the choices you make, not of external forces beyond your control. You decide what to eat. You decide whether to exercise. You decide how to handle stressful situations, whether to let them get to you or whether to shake them off. You decide how to respond to what people say or do to you. It really is all about you.
This is the true purpose of the Heart Book: accountability. The big payoff is that you get to be accountable for yourself, and in doing so, you get to be responsible for what you want to do. And that's how you build a better and better life for yourself.
Here's another hard truth: Lifestyle changes are so difficult to make, due to our very human tendency to stick to our habits, whatever they are, that unless you really become objectively responsible for making new choices, change might always remain out of reach. However, your Heart Book is the key to that sense of responsibility. Look at what you wrote down and decide what you don't like. You can't possibly commit to change until you know exactly what you want to change, and decide it is worth doing. So what about my patient, with her decade-long plan to start exercising? This last time, I decided to press her a bit. I knew she was capable of change. Over the years, I've seen her talk about the intensity of her job, her commitment to her family, her improvements in her diet -- so why couldn't she break through this one barrier? "Why?" I asked her. "Have you figured it out yet? Are you writing in your Heart Book? What is holding you back from this exercise plan I know you want to make a part of your life."
Finally, she nodded, looked down at her lap, and in a voice that was barely a whisper, she admitted: "I never bought sneakers."
Finally, she has become accountable.
For more by Dr. Suzanne Steinbaum, click here.
For more on emotional wellness, click here.