Have you ever gotten one of those phone calls from your doctor the starts out I'm very concerned about what we saw in your mammogram/colonoscopy/echocardiogram?
Then you know that icy feeling in your heart, the buzzing in your brain as your imagination races through successively disastrous scenarios that include pain, disfigurement and death.
Your imagination gets a real workout during the days sometimes weeks of waiting for tests and test results until there is some resolution, either a diagnosis and treatment plan or the opposite: it was a false alarm. All is well.
I have had far too much experience with the former outcome and l know that my life has been profoundly changed by my three cancer and one heart-related diagnoses.
And so until this weekend I hadn't given much thought to the impact of learning that the coast was clear the reprieve following the ominous phone call and the emotionally fraught swirl of activity that follows it. On Friday I got a call from a friend weeping in relief that the mass in her husband's lung was benign, and Nicholas Kristof's column in the NYTimes on Sunday recounted his brush with mortality with the diagnosis of a benign kidney tumor. Their responses were identical: joy, gratitude to their doctors and fervent promises to change their lives; to regularly check their bodies for lumps and to avoid plastics, barbecued meat, second-hand smoke, sunshine and plastic food containers. And they both urged me to do the same.
But my response is more I'm so glad that in neither case is great sorrow and pain in store, not OK then! I'm ditching the microwave! The threat that stopped the hearts of each of their family members didn't migrate to me.
And today I'm reflecting on what it takes the words or images or events -- to get our attention. What makes it worth our while to change habits and inconvenience ourselves in the service of some uncertain future threat to our health? For my friend and Mr. Kristof, it was that threat made real and personal. Both knew the risk of a positive finding was around 90%.
Health communications experts have long argued about whether by illustrating the worst possible outcome, a threat can be made sufficiently vivid to over-ride our foggy and wildly inaccurate understanding of any given risk and provoke us to change our behavior. Remember the Marlboro Man with emphysema or the graphic pictures of lungs on cigarette packs? How about the Public Service Announcements showing horrible car crashes sponsored by Mothers Against Drunk Driving?
While drunk driving accidents have declined and smoking rates trend downward in some groups where the pix on packs are mandatory, this approach is no magic bullet: the threat mostly doesn't migrate. Almost regardless of the threat -- heart disease, lung cancer, diabetes or automobile accident -- explaining it, providing incentives to avoid it, training to ameliorate it and tools to contain it just haven't yet captured our attention sufficiently to get us to act. We're still texting when we drive and eating pizza instead of walking around the block before we go to bed.
Given the success of public health campaigns to date, I doubt there will ever be a magic bullet that packs the kind of wallop that sparks wide-scale behavior change to reduce an uncertain risk. Experiencing a very real threat seems to have the best chance of delivering that Zen slap of enlightenment.
And I wouldn't wish it on my worst enemy.