Office  I spend a lot of my professional life trying to figure out ways to get people to do things they don’t want to do. In Medicine this is called “nonadherence to treatment’; in classic psychiatry lexicon this is ‘resistance”. Really though it is just human nature. We are wired to seek the immediate reward as ‘the future’ was tentative at best. Our monkey brains like food and sex and avoiding unpleasant situations. They aren’t designed to think of retirement planning and cardiovascular disease. I plead, coax, and (sometimes) threaten patients to improve via long time plans often to no avail. Patients – humans really – want short time immediate fixes and results.

I often channel The Cassandra Complex, on which I have written. Cassandra (for thems who don’t know her and/or too lazy to look up that entry) was a Trojan princess cursed by Apollo to always speak the truth but no one would believe her even when she was spot-on correct again and again. I was recently reminded Cassandra had impediments that made the situation worse. If she could have worked on them things might have been more communicative.

1. She spoke in cryptic metaphor. I recently reread some of her wailings and it is no wonder no one could deduce what the hell she was trying to say.

2. She spoke of things too far in the future. People couldn’t connect the dots to what was happening now in their immediate lives to faraway consequences

3. She asked too much of people.

4. She didn’t have any authority.


I keep these Cassandra-mistakes in mind if I want my patients (and myself) to overcome the propensity to procrastinate and avoid anxious endeavors.

#1 is easy. I try not to speak ‘psychobabble”. I move between lexicons depending on the abilities of the patient before me. I need to be clear with my words and what I am trying to communicate.

#4 used to be a sure thing. When doctors spoke it was with an authoritarian-don’t-question-me voice. Those days are over (and probably for the best) but I still hope I have some clout. I am up against what’s on the internet, often pointing out to patients their Google search does not surpass my expertise.

#2 and #3 are more difficult. They are the Scylla and Charybdis of the medical odyssey. Let’s start with #2:

With few exceptions my patients are not dumb. They ‘get it’.  They know if they continue smoking and eating Oreos instead of oranges they are going to have trouble. But the human brain makes long term abstract thinking (and consequences) hard to make happen. This is especially true for folks in their 20s and 30s who all too readily believe they are invincible and they won’t be like their parents (remember thinking that way?).

Defining what is “asking too much” in #3 and how to circumvent it is an ongoing art. I think this is where Medicine as a ‘practice’ gets its namesake. Rome wasn’t built in a day and Naples wasn’t rebuilt in a year. People are more likely to start with – and succeed -with one specific task than a cosmic transformation.  “Give up sugary drinks” is more likely heard and done than ‘stop sugar for the rest of your life”.   “Start walking 15 minutes each day” is better than ‘lose 30lb or else”.  Sometimes if a person travels the sensation-based route of life I entice them via that road. Rather than telling a man with a drinking problem he will die of cirrhosis if he doesn’t stop swilling gin I tell him he will lose easy weight and look better and get better hard-ons. (Hot puppies!).

Being a Cassandra is a frustrating job but with some more careful approach and wording some things may be heard and heeded and I won’t end up with an axe between my shoulder blades.