| Based on the concept of 'locus of control' we can | | | | enquired about exercise and his proclivity towards it. |
| divide the whole human population into three types. | | | | He knew immediately what I was trying to say: |
| Which one are you? | | | | "You are not talking about jogging are you Doc? I am |
| The Internal Controller. | | | | not for that at all, look I reckon in this life God gives |
| This type of person believes that fundamentally they | | | | you a certain number of heartbeats and I am not |
| are in charge of their own future health. In other | | | | wasting any of mine running round in boring circles on |
| words what happens to their health is largely the | | | | wet Sunday mornings!" |
| result of their own actions. This is the muesli eating, | | | | An external controller is not keen on for Socratic |
| brown rice and leather sandal brigade. Those diligent | | | | dialogue, or at least not as far as his health is |
| humans who digest every morsel of health related | | | | concerned. He (or she) wants to be told what to do |
| news from the Guardian or Telegraph health page. It | | | | and then to ignore the advice or not as the case |
| is the type who will not have an aluminum pot in the | | | | may be. They are not really much into involvement |
| house for fear of Alzheimer's and who are to be | | | | and take little or no interest in the media obsession |
| found sweating in health food shops rummaging for | | | | with matters of health. Curiously, research in this field |
| the elixir of life, having just jogged five miles to get | | | | suggests that people with an external locus of |
| there. | | | | control are more likely to be influenced by these |
| There are certain implications for this type of | | | | simplistic vast poster campaigns, much practised by |
| believer, not least that they tend to get very cross if | | | | well intentioned but daft organisations like the now |
| they do get ill. To spend 20 years abstaining from | | | | defunct Health Education Council, exhorting people to |
| the good the things in life to keep ones cholesterol | | | | avoid a variety of pleasurable but possibly dangerous |
| below 5 and then still have a coronary at 55 results in | | | | activities. |
| a very unhappy and disillusioned human being. | | | | Most important for us to remember is that the form |
| As far as communication is concerned, this type of | | | | of medical communication that will work best with |
| person likes explanations, dialogue and Socratic | | | | the internal controller will not work well with the |
| discourse. They want to be involved in decisions | | | | external controller. |
| about their health and they want to know. The | | | | Now we come to the third type of person. |
| medical arguments and explanations do not | | | | The Powerful Other. |
| necessarily need to be rational. This group are | | | | This type of patient is quite different from the |
| enthusiastic about alternative medicine, and, let's face | | | | others. They do not believe they are in control of |
| it a great many medical explanations are at best | | | | their own health nor are they fatalists. They believe |
| dubious and sometimes frankly wrong, but if they | | | | the Doctor and the Doctor alone is in charge of their |
| are convincing the Internal Controller will accept them. | | | | health. |
| The External Controller. | | | | "I have this terrible cough Doctor, I know it's not |
| These characters are the opposite of the internal | | | | related to my smoking because I have been doing |
| controllers. He or she does not believe they have any | | | | that a long time and it has never bothered me, I |
| control over their health. What will be will be. They | | | | would like you to give me something to stop it." |
| are fatalists. A good example is the 'bullet with my | | | | Doctors, of course, see a disproportionate amount of |
| name on' sort of person who can be found down the | | | | this variety of person. Many of those patients that |
| local pub expounding theories as to why these | | | | have been described by jaded medics as 'heartsink' |
| dietary, high exercise, low booze and no alcohol | | | | can be found in this category. |
| theories much beloved of the medical profession are | | | | The powerful others of this world pose another |
| rubbish. | | | | difficult challenge for doctors. Strategies of trying to |
| "My grandfather lived to be 95 and he smoked 10 | | | | give such patients more responsibility for their own |
| large King Edward cigars a day, washed down with a | | | | health are firmly resisted. Getting them involved in |
| bottle of Martell, he had clotted cream with | | | | deciding how to proceed is also difficult as powerful |
| everything and was shot in bed with his 25 year old | | | | others are quite firm on their agenda for the doctor |
| mistress by her jealous husband...etc." | | | | and are at their happiest with authoritarian doctors |
| In my career as a doctor the most explicit external | | | | who relieve them of the responsibility for their own |
| controller I met was a fortyish, unfit mechanic with | | | | health. They are not easily educated and if their |
| an expanding paunch who was complaining of being | | | | agenda for their health does not coincide with the |
| rather run down. Among other things I gently | | | | doctor's, they will not follow the medical advice. |