I think I want to work with patients with diabetes. My undergraduate background includes a lot of sociology and public health, and so I'm really interested in why people act as they do and make the decisions they do. We tend to think that education is always the answer. If a patient has high blood pressure or high blood sugar, send them home with a pamphlet; surely that will help. It must be a knowledge deficit problem, we tell ourselves. We cannot figure out why anyone who had the proper information would not act accordingly. And so we pour ourselves into research, seeking ever more knowledge, grinding our cognitive wheels searching for The Answer and believing it is up there in our heads somewhere.

I have come to believe that the answer lies first in translational research rather than further knowledge acquisition and second in acknowledging that a patient is a person first. As such, he or she is not just a brain when he or she makes decisions but a body, a spirit, a brain, all together, acting according to sentiment, emotion, behavior, whim, constrained by time and money and knowledge and social support and place.

It is not that the doctors and nurses have any lack of knowledge of why someone would have high blood sugar or what that person could do to bring their numbers down. Somehow, though, we are not doing a good job of communicating that to our patients. We approach them from a preaching sentiment rather than from a teaching and partner role, and they tune us out.

"Yes," they say, "I know I should eat fruits and vegetables, but..." and here is where we need to listen for their barriers to change: their neighborhood has three McDonald's and no grocery store and they don't have a car. Or their children won't eat fresh foods and they don't want to cook three separate meals. Or they can't afford to buy salad and fruit and fresh meat. Or they don't know how to cook or are intimidated by it. Or they're working three jobs. Or they're stressed out and use food to self-soothe. We can only learn these barriers if we're willing to listen.

I want to be that patient advocate that takes the time to understand where my patient is coming from rather than throwing out generic solutions, to acknowledge that a person is a product of the social systems from whence they came BUT that he or she is also a dynamic agent with the capacity to make tremendous changes in his or her life. In my own life, I have felt alternately empowered by those who have made me feel like I could change my circumstances and disempowered by those who made me feel like I was too weak, too sick, too stuck to ever make much of myself. The difference between these individuals was largely their capacity to listen to what I was saying and to validate it and take it seriously.

With all the research that is out there, there is no reason that people should be losing limbs and lives to illnesses like heart disease and diabetes. They are preventable in many cases with good nutrition and exercise. But lifestyle habits are firmly entrenched. And so the costs of these diseases are so high, so burdensome on the sufferers and their loved ones. It is troubling to think about all those who needlessly suffer diseases that we know how to prevent, even if the pill is tough to swallow. It will take health care professionals who engage patients in trusting, long-lasting working relationships. Just like you can't uproot an oak tree with your hands the way you would a dandelion, you cannot un-learn lifelong patterns of diet and exercise the way you can un-learn a more innocuous habit like gum-chewing. It takes dedication, knowledge, strong social support, supportive infrastructure and public health systems, engaging follow-up care, and the will to overcome the occasional failure.