By Vicki Rackner, M.D.

What do you do if your loved one makes choices that lead in the direction of disease rather than health? For example, your dad is smoking two months after his heart attack. Your diabetic mom orders pecan pie a la mode. Your sister won’t take her arthritis medicine and suffers in pain. You might wish that your loved ones would stop ignoring you and start making healthier decisions!

Healthcare Advice is Often Ignored

Your loved one isn’t the only person to ignore healthcare advice. Patients ignore their doctors’ orders all the time. Many patients fail to take medication as prescribed.  Some patients ignore the doctor's orders altogether because they disagree with the diagnosis.

Some of the reasons people fail to follow the doctor’s orders (known as “poor compliance” in the medical world), include:

• Unrealistic beliefs about what doctors can do (“If I have another heart attack, my doctors can just fix me.”)
• Denial (“I’m too young to have rheumatoid arthritis.”)
• Failure to understand that small day-to-day choices could make a difference (“My sugars are always out of control. Why bother with the diabetic diet?”) 

The Power of Your Mind

You might have heard about the “power” of hearing what you want to hear, or “selective” hearing.  Some medical professionals estimate that patients hear only about 30% of what their doctors say.

The truth is that your loved one (and everyone else) makes choices every moment of every day.  Each choice can lead in the direction of health…or of illness. You would like to see as many of the choices as possible lead to health. 

Helping Your Loved One Make Healthy Choices

The formula for making healthy choices is the same whether you’re ordering from the dinner menu or deciding whether to undergo an experimental medical treatment. You weigh the potential benefits of an option against the potential risks, and then compare this option with others.

Here are some tips to help you help your loved one make choices that lead to health:

Forge a New Kind of Partnership

Say to your loved one, “Mom, we don’t always see eye-to-eye on what the best choice is.  Our relationship has gone through lots of changes.  First I was a kid and you made choices for me. Then you let me make choices for myself.  Now we’re entering a new phase, and I want to do what I can to make this a strong, successful partnership.  While I respect your right to make your own choices, I invite you to consider that your choices now have more direct consequences for me and the rest of the family.  I love you and I hope that you will make choices that contribute to your health.”

When your loved one sees that his or her choice has a direct impact on the entire family, he or she may think twice about their actions (for example, the effects of not taking prescription medicines).

Gather Information about the Consequences of Health Choices

Sometimes, you need some extra help to “back you up” when helping your loved one see the consequences of a health care choice. The most reliable source of medical information is your loved one’s doctor. Get permission to accompany your loved one to doctor appointments, and, before you go, make sure you prepare yourself so you can make the most out of your visit.

• Prepare for the Doctor Appointment

Say to the person scheduling the appointment, “When Mom and I get home we often have a different understanding of what the doctor said.  We’d like to tape record the visit. Will that be okay with the doctor?” If tape recording is not OK, ask the doctor to write down some of what he or she says.

• Bring a Written List of Questions

Ask your doctor directly about the consequences of medical choices. “Doctor, what will happen to Dad’s heart if he smokes?  What will happen if he quits?” or “Why is regulating blood sugar important?  What are the consequences of high sugars?” or “Will my sister do damage to her joints by not taking pain medication?  Will she become dependent on the medication?”  It’s important that your loved one have a clear understanding of the consequences of their choices. 

• Confirm that the Prescription Signifies an Agreement

When the doctor hands over a prescription, your loved one is, essentially, agreeing to fill the prescription and take the pills, or visit the physical therapist, comply with a diet, or any other advice the doctor gives.  Before you leave, confirm the prescription with the doctor in front of your loved one.  Say, “Mom, I hear the doctor saying that he wants you to take this new medication and go to a physical therapist twice a week. Will that plan work for you?”  Make sure that you get a solid “yes” from your loved one. You can always ask the doctor, “What happens if this plan doesn’t work?  Do we call you?”

Consider a Written Contract

Consider drawing up a written contract that states the behavioral changes your loved one has agreed to.  Sign and date it.  Ask your loved one how you can help them honor the contract.

Understand your Loved One’s Mental State

Depressed people make bad choices.  Recognize that your loved one may be in mourning.  Your father could be mourning the loss of your mother, or the other way around.  Your loved one may be mourning the loss of their independence.  These life changes can trigger depression. If depression is clouding decision-making, treatment of the depression will often help your loved one make better choices.  Say, “Mom, you have been through a lot.  It is normal for people in your shoes to be sad and maybe even depressed.  Depression hurts.  How about if we check with the doctor and see if there’s anything we can do to lift your spirits?”

Be Compassionate 

There’s a reason for everything your loved one does.  Smoking, for example, is an effective (though deadly) stress management tool.  Say to your loved one, “I know in your heart you want to stop smoking.  How does smoking make your life better?”  Then you and your loved one can brainstorm and come up with other ideas of how to achieve those goals.

Express your Love 

Say, “Dad, I love you.  I want the best for you, just like you want the best for me.  It hurts when I see you making choices that harm your health. When you think about smoking, please consider our love for you.  We want you around!”

Understand the Decision is Ultimately Your Loved One’s Choice

The major privilege of adulthood is the ability to choose. Even when your loved one has lost some independence, they are still competent to make day-to-day choices until proven otherwise. The exception to this is when your loved one’s ability to make competent safety and healthcare decisions is compromised.

The mom who leaves the stove on yet insists on remaining in her home, or the father who pays the same bill two or three times need advice, help, and sometimes 24/7 supervision.

Until that time, you can try to influence your loved ones’ choices.  The reality is that their choices are theirs to make.  Your most powerful tools to influence choices are information, compassion and love.  Your toughest caregiving challenge may be supporting those you love even when they make choices that harm their health.