Friday, November 4, 2016
Listen to (Don't Ask) Your Doctor
One of the key behavioral dimensions is discipline: doing what needs to be done in the proper timeframe. The opposite of discipline may be procrastination, but discipline also includes actions like delaying gratification and impulse control. The important thing to understand about discipline is that it is not particularly challenging mentally. It’s usually easy to understand what needs to be done. All the steps are laid out and reasonable. The difficult part comes in the doing.
I call discipline the diet dimension. What needs to be done to lose weight and keep it off is easy to understand and common knowledge, eat less and exercise more. Actually doing it is the challenge. People make fortunes selling books and diet programs, some with tricks and secrets, foods to eat and foods to avoid. Many just provide help with eating and/or exercising. When the program is over and if it worked, most people gain back what they lost because they lack the discipline to stick to it.
Dieting is not the only example. Success with personal finances falls into the same category, as does quitting smoking or correcting any other bad habit. Even little habits we should develop like brushing and flossing, regular medical checkups and eye exams fall into this category. These aren’t even hard to do; they just require some attention and the ability to stick to a schedule.
Discipline is very important because it can have long-term effects on our health and happiness. Part of what makes it difficult is that the consequences are often far in the future. The cancer from smoking, the anxiety-filled retirement from lack of savings and all the diseases associated with obesity are far in the future. The pain and sacrifice of sticking to a program happen today. Key here is that by the time delayed consequences strike, it may be too late to take corrective action.
Recent advice from the American Heart Association (AHA) gives another example. “It is estimated that three out of four Americans do not take their medication as directed.” This seems like a no-brainer. Instructions are usually clearly printed on the label and reinforced by the doctor or pharmacist. Those who have questions can easily find resources to help them out. This is a clear case of problems with discipline. And as in the examples above, the consequences are serious and often delayed. The AHA goes on to say, “poor medication adherence takes the lives of 125,000 Americans annually, and costs the health care system nearly $300 billion a year in additional doctor visits, emergency department visits and hospitalizations.” Remember, costs to the system, costs to society, are costs to you and me.
This advice is not new, but it is now based on clear evidence. A new, very thorough study looked at outcomes of more than 3,200 heart patients who underwent either bypass surgery or insertion of a stent to keep vital blood vessels open. That’s a very large sample. Follow-up exams 12 and 18 months out showed much better results for the patients who took their medications as prescribed. They “were more than twice as likely to have complication-free survival than those who did not take their medications as prescribed.” Once again, discipline pays off.
This is why wise parents try to instill a sense of discipline in their children: eat healthy food before getting dessert, do your homework or set aside the time before enjoying more fun activities, buckle your seatbelt, don’t text while driving and prizes and rewards are earned, not bestowed. A famous experiment many years ago showed that children with a sense of discipline even at a young age tended later in life to be more successful in academics and careers.
Unfortunately the surest way to instill this sense of discipline in children is to lead by example; and from diets to drugs (legal and illegal), so many Americans struggle with this behavioral dimension.