Does your dog feel like I do after a visit to my doctor?

When I meet with clients, I often try and find a human-based analogy I can use to help them understand what is going on with their relationship with their dog. I especially like to find a human example to explain punishment-based vs. positive training.

Recently, I experienced a very punishing event and I think it is a great example of how punishment can harm a creature, whether it is a person or a dog.

cks falcon column

I know I am overweight. Yelling at me and making me feel bad are not good ways to help me lose that weight. Falcon loves to jump on things and explore, but had I dragged him up this small incline when he was a puppy, he might now feel scared about trying new things. Instead I rewarded him for making a step or two up the incline.

I am of the age (late 50s) when the family doctor really ramps up the “change your life” talks. I’m overweight, my cholesterol is high, my blood pressure is high and my blood sugar is two numbers above high normal, making me pre-diabetic. I have been practicing the behaviors that led to these numbers for the last 25 years of my life.

However, I do want to change. Last year I tried on my own to lose weight, but it didn’t happen and I gave up. This year when I went in January for my annual checkup, I was determined to do better and had a plan to talk with my doctor about a drug she had mentioned last year that might help me.

I was all set for a positive conversation. But, I was not set up for success. My doctor’s exam room, like many a doctor’s exam room, is tiny. I was sitting in a chair in the corner trapped between a wall and the exam table. Because the door to the hallway was closed, it made the room even more stressful. I anxiously waited for the doctor to come in and reveal my fate.

The doctor walked in, stood in the doorway staring at me and said “I am not happy with your blood pressure.” I immediately stopped listening to her because my brain went to, “OMG, I’m going to die. High blood pressure kills more women than men. What should I do, how much time do I have?” I could not process what she was saying because I was incredibly stressed.

(imagine your dog is worried when it sees other dogs on a walk and you want to teach your dog not to be worried by telling him that when he sees another dog he can have a piece of chicken. But, because he is so worried about the other dog he doesn’t realize you have chicken so he can’t make the connection. You may decide he is stubborn or not listening. Worse would be if you jerk him really hard with a prong collar or scream at him. Then he would be worried on another front and he still wouldn’t be able to process what is happening because all he can really see is how close that other scary dog is).

After I got past the part about the blood pressure, I realized the doctor was telling me how worrisome my blood sugar numbers were. She asked me how many Cola beverages I drink a day and how much candy I eat. What my mind interprets is she is obviously telling me this is all my fault. I drink too much pop and eat too much candy. There can be no other explanation for my weight.

At the very end of our conversation the doctor tells me my cholesterol numbers are amazing and they have really changed in a positive way over the last year. As she walks out the door she asks, “does anyone in your family have diabetes?” I tell her my maternal grandmother did and one brother does. She says, “well some things are genetic and you just can’t do anything about them.” And she walks out the door.

I am now really confused as I don’t know if the blood sugar number is my fault or if it was caused by something I can’t control.

The doctor returns with a book entitled Carb Counting and Meal Planning, tools to help you manage your blood sugar. She hands it to me and says, “I really think you need to try Phentermine. It can help you get started losing weight, but don’t think you can just take this drug and eat whatever you want. You have to change what you are eating.”  She also told me I had to come in every month and be weighed before she would refill the prescription because she wanted to ensure I was “really trying and actually losing weight.”

And that was the end of our conversation.

I was left sitting in a scary room with a book I didn’t understand and feeling as if I am probably going to die at any second.

I left the doctor’s office totally stressed out. I was depressed. I wanted to go home and eat an entire block of cheddar cheese on French bread. Instead, I went to lunch and had a grilled chicken breast on a plate (no bun) with a side of cottage cheese and a glass of unsweetened iced tea.

Wait, so I am saying punishment worked right? And it did. I was scared enough by the doctor and the numbers and decided to change how I was eating. But, why use punishment if my behavior could have been changed in a less stressful way? Some people may have left that visit feeling so absolutely crushed they never go to the doctor again. They may have felt alone and suicidal. That is the problem with punishment; you don’t know how it affects the learner until it is often too late.

How did I want my doctor to behave?

cks sky column

Instead of feeling punished for not making enough progress, I would have been happier to get some rewards for the good work I had already done. Skywalker loves to work for me because he knows something fun will always happen.

I could have been placed in a room with more space or at least a less sterile environment. The doctor could have come in and immediately sat in a chair opposite me instead of standing in the doorway blocking my escape route. She could have started a conversation with, “Your cholesterol numbers are really improved since your last visit. Whatever you are doing is really working. Tell me what you have been doing to make such a great change in this number?” I would then be at ease and able to more freely talk about what I am eating, which might give the doctor a clue as to how my dietary habits are affecting the other numbers.

Next, my doctor could have said, “I am a bit concerned about your blood sugar and your blood pressure. Let’s talk about some of your daily meals and see if we can brainstorm ways to get these numbers going in a better direction.” At which point my doctor would have learned I do not drink cola beverages of any type nor do I eat a lot of candy. I’m not saying I never eat a piece of chocolate, but I would be able to easily count how many pieces I might eat each month. I don’t eat deserts. I do however eat a lot of bread. That might have been a good place for us to start a conversation. And she could have asked more about my family history at which point we could have had a conversation about what it might mean to my overall health care plan if I have a family history of diabetes. In the conversation she may have learned how scared I am as I near 60 because my dad died at 62 and my mom died at 68 and the age I am right now is the age my mom was when she found out she had breast cancer.

Next she could have talked about the phentermine and how it might give me a boost so I have some success right away, which would then encourage me to keep trying. She could have said that I needed to come back each month so they could track my weight loss progress and to ensure none of the scary side effects of this drug were becoming an issue for me. Then she could have said “I know it is difficult keeping track of calories and carbs and trying to figure out what to eat and what not to eat. Here is a book some of my patients have found helpful in terms of figuring out what they are eating and how it might be affecting their bodies.”

Perhaps she could have also suggested a visit to a nutritionist for me.

I wish I could say the story ended there, but it actually got worse.

I went back for my one-month visit to have my weight recorded. I had already learned from Facebook friends following my posts on this subject that there are a LOT of people out there who have serious anxiety about stepping on that scale. I talked to two people who don’t go back to the doctor at all to avoid the punishment of the scale. So, I know I am not the only one who dreads going in to be weighed and doctors should know this.

But, I was actually happy because I had lost weight. I knew I had lost at least five pounds and my scale said closer to eight pounds. The technician weighed me, wrote the number on a post it and went back to the office where she had to put it into my record. I could also see my doctor in the office and the technician showed her the piece of paper with my weight on it.

Finally the technician came out and walked toward me with a book in her hand — it was the carb counting book. I told her the doctor had given me that book a month ago. The technician then said, “The doctor wants to know if you understand the book and how to use it?” SERIOUSLY?

(imagine a dog who keeps getting yelled at even though he thought he was doing the right thing, but obviously is learning people are difficult to understand)

I was utterly defeated. I shrank down in myself and whispered, “but I’ve lost weight right?” At which point the technician said, “well the doctor thought you would have lost more by now.”

(imagine yelling at your dog because he has not made enough progress in a few days to change a behavior he has been using for the last 8 years)

Had the doctor or technician had a conversation with me they would have learned that in the last month I had not eaten a single piece of bread or eaten at a fast food restaurant. I had cut out what few deserts I had been eating. I was cooking most of my dinners instead of just stopping on the way home and grabbing something from the drive through and most of my dinners were riced cauliflower with some type of protein added. I had dropped my calorie count to under 1600 a day and I was tracking my calories with a phone app.

Instead I got my prescription refilled with the admonishment to “try really hard this month.”

I sat in my vehicle in the parking lot and burst into tears and I am not a person who just bursts into tears. I was utterly defeated. I wanted to lash out at the doctor. I wanted to pick up a big rock and throw it at the building. I was so angry and frustrated and I had no idea what to do with my feelings.

(imagine a dog who has so much conflicting information and is under so much stress that he lashes out and snaps or growls at the nearest person)

Luckily, I was able to post my feelings on Facebook and I discovered I was not alone. I heard from more than 100 people via comments, private messages and text messages. Many of them had similar stories. Some of the people who were outraged at how I was treated were dog trainers who use punishment-based training techniques. I think this shows some people don’t really want to use punishment if they think about it, but instead most people just go with how it has always been done.

So, my question is, why would you want to make your dog (or other animal) feel the way I now feel about a behavior I am trying to change? Yes, punishment can make me change this behavior, but it can also backfire and cause me to stop all this hard work and just go eat that big block of cheddar cheese with French bread.

If you are in any type of position where you teach or coach a person or an animal, always consider kindness. Remember how great it feels when you are rewarded for a great job and how punishing it feels when you are told something isn’t going well. It is especially punishing when you don’t understand the reason for being punished.

I believe all of us can try harder to be a little kinder to those whose lives we touch.

 

2 thoughts on “Does your dog feel like I do after a visit to my doctor?

  1. efotsch

    Thank you so much for sharing your story Connie! This is truly informative and can help me (and others like me) to learn patience when dealing with our animals (and other people).

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  2. Bonnie Lacombe

    Thanks so much for sharing. I too am in the same boat that you’re in and the same age. I know most of my issues are genetic and compounded by sitting in front of a computer 10 hours a day for the last 20 years. I thank God I have a fantastic doctor that listens. I will now always keep your story in mind when trying to explain why positive is so much better than punishment. Also, go look for another doctor.

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