The irony:  I’m in my paper gown, waiting for my physical.  To while away the time, I’m re-reading Last Child in the Woods by Richard Louv.  The doctor comes into the room, and I slide the book back into my purse, my mind still on Louv’s argument that spending time in nature makes us healthier.  In fact, in the last sentence I read before putting the book Louv points out that, in 1699, “the book the English Gardener advised the reader to spend ‘spare time in the garden, either digging, setting out, or weeding;  there is no better way to preserve your health.’”

Then my physical begins.  My regular doctor is off on maternity leave, so I see the locum.  She’s a warm, respectful woman with a ready smile.  She shows she cares by answering questions thoughtfully.  We review the blood work that I had done the previous week.  Triglycerides good, blood sugar good, cholesterol fabulous, iron a little low.  We review the nurse’s exam:  weight good, BP good.  In other words, it’s all about the numbers, and my numbers are fine.

Other than asking after my children, she doesn’t ask me any personal questions, and, after years of experience doing health-related ethnographies, I don’t really expect her to.  I’m aware that she may well be doing some sort of assessment of my overall demeanor, but if she is, I “pass” without any further exploration of my thoughts, feelings, experiences or lifestyle.  We part, and I agree to watch my iron, and to update my tetanus shot in a few years.

All in all, it was a perfectly normal physical, one that I was lucky to have in a world of unequal access to health care.  But it also highlighted that, officially anyway, we still have a narrow vision about what matters when it comes to health and wellness.  We know things other than cholesterol etc. matter, but they’re time-consuming for physicians to take on in the clinical encounter, and more to the point, they don’t fit comfortably into the prevailing scientific discourse.

Here are 10 questions I would have loved to hear my doctor ask:

  1. Do you know where the food you eat comes from?
  2. To quote Michael Pollan, do you eat food, not too much, mostly plants?
  3. Do you regularly spend time in nature and know the native species of your neighbourhood?
  4. Do you feel your life has purpose?
  5. Is there human touch in your life?
  6. Do you have the chance to interact regularly with people who different than you – older, younger, of different backgrounds and abilities?
  7. Do you give?
  8. Do you give thanks?
  9. Do you move?
  10. Do you regularly eat with people you love?

The vision of health that lies behind these is completely different than the one captured in blood tests and weight measurements.  Health here isn’t just about risk minimization and calibrating the chemistry of the body to mitigate the crappy things we do to ourselves.  These are important, but shouldn’t a vision of health also be about living?   These questions would have asked me whether I’m connected to people, to the natural environment, to what I put in my body, to a spirit of life.

This isn’t just some Romantic sentiment:  there’s no shortage of evidence that the behaviors interrogated by the questions above contribute to better mental and physical health.  We don’t always know why they do.  Sometimes it’s straightforward:  if you put healthy, unprocessed food into your system, your body will be better off.  Sometimes it’s harder to pinpoint:  for example, we know spending time in nature can reduce cortisol (stress hormone) levels – elevated levels of which are linked to any numbers of chronic illnesses – and improve feelings of well-being, but we don’t know why that happens.

My doctor probably won’t be asking me those questions any time soon.  But I can ask them of myself, and raise them more broadly, along with one of the most important questions overall:  what’s the culture of health that we want to create?

The only way we should be assessing our health?

 

 

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