Fixed Mindset

I spend more and more time with patients talking about their medical problems that are not emergencies. The vast majority of the time, any actual emergency condition is ruled out very quickly. Occasionally, a critical diagnosis is found after quite a long time in the ER, but that’s the exception rather than the rule. So once the actual emergencies are no longer part of the discussion, we can focus on other things.

I spend a decent amount of time trying to improve myself, and I have many similar people with the same mindset in my life. It’s referred to as a growth mindset versus having a fixed mindset. I don’t think there’s a test for this condition, but if there were, I think I could predict what most of my patients are within just a few minutes of conversation.

Last night, I had a woman with kidney stones. Kidney stones are most often from calcium oxalate. This woman loves her vegetables, particularly spinach, which is loaded with oxalates. So we had a conversation about the fact that perhaps she should not eat so much spinach if she wants to avoid having a kidney stone again.

She was otherwise relatively healthy, did not take a lot of medications, did not like to take a lot of medications, but she was pretty convinced that she needs to eat her vegetables to be healthy—despite the fact that it’s probably her vegetables that are causing her kidney stones.

Last week, I had a conversation with a woman that is reminiscent of many conversations I have with patients about constipation and abdominal pain. They often insist that they eat a “healthy” diet, but yet they’re in the ER with abdominal pain, and even when they’re not in the ER, they have constipation, diarrhea, bloating, discomfort. They have often been to GI specialists; they have been to primary care; they are often on medications to help with their IBS. And when I suggest that perhaps they should change what they’re eating, the fixed mindset makes itself apparent.

Patients just don’t want to believe that what they are doing is incorrect. It takes humility to admit when you are wrong. It’s discomforting to admit that you have done something your whole life and it was not the right thing to do.

I heard a quote recently about challenging the consensus opinion. Depending on the topic, we get very bent out of shape and refuse to challenge a consensus opinion. But the quote was pointing out how often the consensus opinion has been wrong. If we like the consensus opinion, this goes against our very being to admit that we are wrong. If we did not like the consensus opinion, we are happy to go along when it is shown to be wrong.

It’s also much easier to just go along with the status quo. Once your health has deteriorated, it’s incredibly hard to try to get it back. It’s much easier to just remain within the system of big medicine, depending on someone else to help you. There is less cognitive dissonance with a fixed mindset and poor health. You can just keep telling yourself that you’re doing the right thing despite all of the evidence to the contrary. You tell yourself you don’t have to change. You tell yourself that what you’re doing is correct.

And if this is you, your life will keep deteriorating and your health will be miserable.

People change when the pain is great enough. And not before.