“I Don’t Do Windows” Says the Maid. “I Don’t Do Machines” Says this Doctor – “But I Do Nudge Therapy”


The hackneyed windows phrase, about what a domestic employee will and will not do for an employer, represents a concept that applies to the life of a doctor, too.

Personally, I have to do Windows, the default computer system of corporate America, even though I despise it. But in my personal life I use iOS on my iPad and iPhone and very rarely use even my slick looking MacBook Pro. I use “tech” and machines as little as possible and I prefer that they work invisibly and intuitively.

In medicine, even in what used to be called “general practice”, you can’t very reasonably do everything for everybody. Setting those limits requires introspection, honesty and diplomacy.

In my case, I have always stayed away from dealing with machine treatments of disease. But I do much more than just prescribe medication. Since the beginning of my career, and more and more the longer I practice, I teach and counsel more than I prescribe.

I have decided not to be involved with treatment of sleep apnea, for example. It may sound crass, but I don’t find this condition very interesting: The prospect of reviewing downloads and manipulating machine settings is too far removed from my idea of country medicine.

Worse than CPAP machines are noninvasive respiratory assist devises. I won’t go near those.

I similarly defer to my local hospital’s diabetes nurses to manage insulin pumps. This, too, is too much of a mechanical task for my temperament.

In my personal life, I have done wound care for horses many times, but I have never changed the oil of any of the cars I have owned and loved.

I have also found it more and more interesting and rewarding to engage with patients in what might be called nudge therapy. The word microtherapy is already taken and stands for using low levels of electricity on people, which is not my cup of tea. Microcounseling is also already taken, and stands for briefly coaching non therapists about techniques they can use.

Nudge therapy is when I in a brief appointment can apply cognitive therapy principles to gently and quickly nudge a person towards a different interpretation of their symptoms or circumstances. I find this incredibly powerful sometimes. In my Suboxone clinic, for example, I often deliver these kind of messages, which in some cases have a direct result on my patient’s outlook and sometimes sells them on the idea of adding individual counseling to their regular group therapy.

Changing how the mind, or the body, works without drugs, dials or electricity – now that’s inspiring!

(P.S. As I searched for previous use of “Nudge Therapy”, I came across “Therapeutic Nudging“, which basically consists of reaching out between appointments, something I have also found to be incredibly powerful.)

Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.

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