The dangerous road of denial

Any combination of poor lifestyle choices will lead to serious health problems.

‘‘Why do you want to talk about a river in Egypt,” asked Sally, one of the participants of a focus group, composed of people of all walks of life and tasked with finding workable and acceptable solutions to make health care more efficient and less expensive.

That question was directed at me and at first I did not have a clue why the question.

Sally explained;”We are here to talk about health care, not the river Nile.

I must still have looked puzzled and she impatiently repeated: “The Nile, what has that river to do with our health care?”

Suddenly the penny dropped and I started laughing and said: ”You can blame my Dutch accent that you mistook the word “denial “ for the Nile.

After a moment of great hilarity among the other participants, I shared my observation that denial, or refusal to come to grips with a problem was a universal and bad habit leading to a lot of frustration and harm. Denying you have a problem is not going to solve it, nor will ignoring it make it go away. Yet, all too many individuals, and worse, people in charge of organizations and governments, take this approach of refusing to acknowledge there is a problem when clearly there is one.

On the personal level, anyone with any brains knows full well that any combination of lifestyle choices of smoking, drinking to excess, drugs, choosing to eat lots of junk food and lack of exercise will eventually lead to a serious health problem, increased health care costs and a shortened lifespan. All I need to do is look around in any supermarket and I see a great many people who are unmistakably in denial.

In my office I would see patients who neglected their diabetes and I would try and paint a picture of what kind of reality they would have to face over the long haul. Not to scare them, but to explain how making better choices would improve the outlook for a healthier and happier life. Many did listen; others did not, until it was too late.

I clearly recall one, nice 30-year-old man who was in total denial that his lifestyle would eventually cost him dearly. He was a solid citizen, a hard worker, strong as an ox, always upbeat, happily married with two sons. His always said his family came first and for the moment that was true. However, he failed to see that in the long run he would he would  not be able to live up to that commitment on account of his refusal to accept he had a problem.

Twenty years later he found himself in a hospital with both legs amputated, in kidney failure and legally blind, all as a result of his refusal to cooperate with the management of his diabetes.

Despite of his non-compliance with sound medical advice, I continued to like the man, his macho, upbeat persona. I felt deeply sorry for him when, in the end, he prematurely turned into a human wreck. During one of my hospital visits, he told me then he did not believe a word of my predictions 20 years ago, but wished he had listened instead of thinking he was invincible and could do as he pleased.

Denial in our society does not stop with individual behaviour. Too many parents appear to turn a blind eye when they allow their children to become overweight, even obese. Currently, one out of every four children suffers that fate.

I have always assumed that most parents want the best for their children. Yet when parents brought in a child for a regular checkup, injury or an acute illness and on examination the child appeared quite overweight, I would deal first of all with the presenting problem and, in addition, tried to share my concern about the unhealthy weight. I quickly learned that if the parents themselves were overweight, I did not need to bother. More often than not, it was like talking to a blank wall. Some became outright angry with me. They did not realize that by refusing to see there was a problem, they condemned the poor kids to a future with numerous health problems.

The lesson I learned: denial is a very powerful emotion that can easily override rational thinking.

On the political scene, the phenomenon of systemic denial is even more serious, since it affects us all at one time or another.

Our political leaders have been doing a lot of talking about health care renewal, establishing royal commissions, tinkering a bit here and there, pouring in extra billions without materially improving the health of the population.

In other words, lots of talk and no action.

I will be the last one to think the issue of how to maintain an effective publicly financed healthcare system serving people promptly when and where they need it without bankrupting the country is an easy one to solve. On the other hand we already pay for a first class system and getting not nearly enough value for money.

In a next column I will suggest a number of solutions. Most of them have been around for some time, but the people in charge have lacked the resolve or blocked implementation. Unless we come to our senses, we will  collectively go down the same road of denial as my very nice diabetic patient did with dire consequences looming.


Dr. Marco Terwiel is a retired family physician who lives in Maple Ridge.

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