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Lessons in Patients : Doctors Find Dispensing Advice Easier Than Taking It

September 05, 1993|PSYCHE PASCUAL | SPECIAL TO THE TIMES

LONG BEACH — Dr. Stephen Brunton is used to having his instructions followed--by his patients and also by the family medicine residents he oversees at Long Beach Memorial Hospital.

So when Brunton prescribed a month of clean living to nine first-year residents, he was understandably taken aback by the results: All but one cheated.

Like sinners at a confessional, the doctors admitted to bingeing on soft drinks, scarfing desserts and furtively playing computer games that they had promised to give up.

But Brunton was not entirely unhappy about the outcome. The lesson in deprivation, he said, is an unorthodox way of teaching young doctors to be reasonable and realistic when forcing their patients to give up the unhealthy things they enjoy.

"As physicians, we don't necessarily have the lifestyles we'd like our patients to (have)," Brunton said. "I think if a person develops a sense of humility, if you walk in the slippers of your patients, you see things a different way."

Brunton doesn't encourage patients to have unhealthy habits, but he is understanding when they have less-than-perfect willpower. Once a heavy smoker, he admits it was hard to give up cigarettes, and he sneaked a few before he quit entirely.

Every day, doctors warn patients to lose weight, eat healthy foods, get exercise, quit smoking or stop drinking alcohol, Brunton said. But when patients fail, doctors sometimes get angry.

"There's very little tolerance for patients," he said. "(Doctors) can't stand it that people don't do what they're told. Sometimes physicians punish patients" by criticizing them and, in some cases, discontinuing their care.

"They say, 'Obviously if you're not going to help yourself, I'm not going to help you,' " Brunton said.

Before the experiment began in July, Brunton met with the residents to discuss what they would give up.

Some chose to avoid television or computer games. Others chose soft drinks or sweets.

Dr. Karima Hirani, 28, said she thought giving up soda pop would be a small sacrifice, since she had cheerfully endured three grueling years of medical school. But long hours at Long Beach Memorial Hospital, coupled with the stress of delivering babies in Harbor-UCLA Medical Center's fast-paced obstetrics unit, were too much, she said.

"When we'd go down to the cafeteria, there was the Coke machine, and all my team members would be having a Coke," she said. Finally, after only two weeks, she broke down, plunked her money into the machine and popped open a can.

"There wasn't an ounce of guilt," she said with a grin.

Other doctors shared similar stories of failure.

Dr. Sokkun Kimpau, 25, said she is a "candy addict" and couldn't give it up, but did agree to give up cookies.

"I used to counsel people on quitting smoking. I would say, 'Why is it so hard?' " she said. "It's inconceivable to me (that) you can't quit."

During the second week of the program, Kimpau nervously contemplated half a package of fig bars left for her by another doctor.

"It was staring at me. I just wanted it. I said, 'Oh, this isn't a cookie. It's a Fig Newton!' But I realized that was silly," she said. Finally, cookie in hand, she abandoned her promise.

After the month was over, the residents celebrated the end of their fast with a junk-food lunch of pizza and soda. Some said the experiment made them frustrated and angry.

"I cursed you," Hirani sneered at Brunton as she sipped a once-forbidden Coke.

After Kimpau shared her cookie caper, the group of doctors broke into peals of laughter, then soberly offered suggestions on maintaining willpower. When you have the urge to gobble cookies, they told her, go for a walk.

Patients on restricted diets should be given permission to cheat once in a while, Brunton said, and they should be given healthy substitutes. Friends and relatives should be warned not to sabotage family members.

Kimpau said she intends to use the lesson of her failed attempt to give up cookies when she treats patients in her native Cambodian community.

"Now I can use all the tools we've shared," Kimpau said. "I would be very understanding. I wouldn't expect someone to just quit smoking or eating."

Hirani said giving up soft drinks forced her to understand why kicking bad habits is so hard. And it helped her see why doctors sometimes expect too much of their patients.

"You're under pressure to learn as much as you can about your patient in a little amount of time. You're so focused on trying to find out what's wrong with them, you forget they're human beings," she said. "I think Dr. Brunton's program has taught us to be more humane."

Brunton said he learned about his own weaknesses when he tried--and repeatedly failed--to give up sweets. He attributed his downfall to luscious slices of cheesecake and rich Napoleon desserts that seemed to appear when he felt most vulnerable.

Exposing first-year residents to unusual medical experiences is nothing new at Long Beach Memorial Hospital.

Seven years ago, Brunton invited residents to begin their three-year stay at the hospital by spending the night as patients.

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