Dire Consequences

July 6, 2010

Recently my husband, son, and I had a very serious conversation. My son was caught sticking Legos in his ear earlier in the day. My husband and I both emphasized to him how dangerous this could be. We painted a picture of dire consequences if he got a Lego caught in his ear.

Recently my husband, son, and I had a very serious conversation. My son was caught sticking Legos in his ear earlier in the day. My husband and I both emphasized to him how dangerous this could be. We painted a picture of dire consequences if he got a Lego caught in his ear.

“We’ll have to take you to the hospital to get it taken out,” I cautioned.

“You may need to get a shot,” my husband added, playing on our son’s inherent dislike of needles.

My son nodded solemnly. “I might need to get a sharp knife stuck in my head,” he volunteered. I laughed, reassuring him that a misplaced Lego was unlikely to warrant neurosurgery. He seemed to get it. Time will tell if our cautioning, admonitions, and warnings will keep Legos out of his ear canals.

This scenario made me consider the times when I use the threat of dire consequences with my patients.

“If we don’t get your blood sugar under better control,” I warn, “your kidneys may fail and you’ll end up on dialysis. Uncontrolled diabetes is one of the leading causes of renal failure.”

“I know you don’t like to take the statin, but if we don’t get your LDL under better control, you may have another heart attack.”

“Make sure to finish the entire course of antibiotic or the infection could come back and be even harder to treat next time.”

Why do I paint these worst case scenarios for my kids and for my patients? Part of it is my sense of loss of control. What my son does with his Legos in the privacy of his bedroom is largely out of my control unless I plan on watching him every day, all day. Same goes for my patients – unless I do stealth home visits, I won’t really know if they are taking their insulin until I get their next A1C level in three months. My lack of control combined with a desire for a specific, safe, and healthy outcome leads me to rely on fear and warnings to encourage compliance with my recommendations and instructions.

I’m not sure how well this approach works. Some of my patients (and kids) tune me out when I start describing possible fates. But, I do have to say that we’ve not had to make a trip to the ER to remove any toys from ears or noses this week.