Updated: Apr 25
Usually my patients express a sense of relief when I report that their blood test results are normal. But sometimes they seem strangely disappointed. They’ll say things like, “Oh well, I guess that’s good, but now I won’t be so motivated to do the (fill-in-the-blank) healthy behavior that I was wanting to do.” It’s like they needed to be scared by the concrete evidence that something was wrong, in order to choose to become healthier.
Limitations of check ups
And what I want to say is that in over thirty years in primary care, I’ve never seen fear be a sustainable motivator. I get that we believe that feeling bad about the lab results will get us to focus on improving our health. But it only works in the short term. There are a couple of reasons for that.
The first is that blood tests are actually quite a blunt measure of health. We think that we should be able to get an accurate measure of our overall health when we get a “check up” panel done. But actually such panels are usually designed to find out if there is something seriously wrong with your liver or kidney function, or blood counts. In other words, screening tests are typically designed to look for major abnormalities that could be life-threatening, not subtle problems
The second is that it’s not practically possible to check everything, and while some doctors will look at hormones or nutritional parameters, such tests may not always be warranted nor covered by insurance.
Having said that, it’s important to acknowledge that lab results are only one component of a full routine check up. Physicals are an excellent opportunity for your health care provider to examine your body, review for potential red flag symptoms, and consider other preventive health measures like screening xrays or vaccination.
Fear as motivation
Another reason is that while unfavorable lab reports like high cholesterol or blood sugar can motivate short term changes in diet, it’s sometimes harder to sustain these choices over time. People often have to experience some significant consequences in order to make such changes, like actually getting angina chest pain or maybe having a close friend start having to start diabetes medication.
I’ve definitely seen people make major changes in health behaviors based on fear. They may exercise a lot more or lose weight, but it often only lasts for months. Sometimes it can be because they are disappointed by how their follow up blood tests don’t reflect as big an improvement as they believe it should, based on the level of effort expended.
Fear can be a motivator, but I just haven’t seen where it is the best motivator over time. I believe that it’s because while fear can push us to work hard to run away from the thing we fear, it doesn’t keep us going in that direction.
Owl versus cheese
In their book Burnout, Emily and Amelia Nagoski cite the famous 2005 Friedman and Forster study where college students were asked to solve maze puzzles with a cartoon mouse, based on either having to escape an owl overhead or getting the reward of cheese.
The idea is that when we are trying to get away from the owl’s talons, any direction will do and the motivation is gone once the perceived danger is gone. But if we have a rewarding goal at the end of maze, we will keep trying even if we keep hitting dead ends in the maze.
Momming my brain
So coming back to my cholesterol or blood sugar, it makes sense that fear or shame about “a bad report card” (my owl) won’t be a sustainable motivator for me to change my lifestyle. Because after all, they are only numbers on a sheet of paper and have no bearing on how I feel day to day.
My brain function is critically important for creating that vision of my future self
What I really want is a healthy brain with good energy, alertness, memory and focus every day. And I want to protect my brain against potential injuries that can be caused by having elevated cholesterol or blood sugar. I love the idea of living to my nineties, enjoying the company of my friends and family, living independently and doing work that I love like painting and teaching (my cheese).
When I envision my future self, I see how critically important my brain function was for creating that reality for myself, and so of course I’m unwilling to let that vision be subject to random chance. Being in love with that nonagenarian version of myself shifts my energy with a power that fuels me to be the best mom I can be for my brain.