\”I know this is all because of my weight,\” she said to me, explaining a myriad of symptoms she had just unloaded on me.  \”My mother constantly tells me I need to lose weight, and whenever my brother gets mad at me he calls me \’Fatso.\’\”  Obviously, coming to the doctor would be another opportunity to be lectured about her weight problems as well.  She was living in the harsh spotlight of shame cast on her by everyone around her, and especially cast on her by her own thoughts of her failings, her weakness, her defectiveness.

Her lecturers are ignoring the incredible stress in life (much less the difficulties of growing up in a family that uses shame as a weapon), and ignore the obvious truth: it\’s very, very hard to lose weight.  If it was an easy thing to do, why would there be so many obese people in our society?  Do people wake up each day hoping they can be obese instead of thin?  Do people not understand the concept of eating right?  Is obesity a sign of stupidity?  Is it a sign of moral defectiveness?  This is certainly the message my overweight people seem to have gotten.

It\’s not just the obese people who feel the need to apologize about their defectiveness.  My diabetics who don\’t control their sugars apologize for their lack of self-control.  My depressed and anxious people feel that it\’s their own fault that they are this way, and that if only they lived a better life they would be happy.  Parents of sick children assume they are the ones who brought this on, ruing their choice of putting the child in daycare.  Parents of children with behavior or academic problems assume that \”if only they would have been better parents,\” their children would be doing much better.

Life would be so much better if they just did the right thing.

To a degree, these people are right: it is better to control your diet, exercise, take your medications, count your blessings, live one day at a time, and be consistent, loving parents.  I would never argue that this isn\’t the immediate cause of their problems.  But we humans are not so simple.  We each carry around a self-destruct button we push at varying intervals.  Some people compulsively spend money, others can\’t control their anger, while others pathologically procrastinate.

I haven\’t met anyone who doesn\’t carry their own self-destruct button.  All of us ask ourselves the questions: \”Why can\’t I stop doing that?\”, \”Why can\’t I keep my mouth shut?\”, \”Why is this so hard for me when it seems easy for other people?\”, or simply, \”What\’s wrong with me?\”

Here\’s what\’s wrong: we are humans.  It was in the fine-print that we signed when we were born:

You agree to the following:

  1. Your life will end, as will the lives of the people around you.
  2. You will experience pain and loss.
  3. You will make bad choices – some accidental and some not.
  4. The other people who signed this contract are just as confused as you, and so will sometimes act in ways that bring you pain.
  5. Life will be unfair at times.
  6. Life will really suck at times.

Don\’t remember signing that agreement?  Of course not!  You were just an infant.  How much of your first days on earth do you remember?  Yet we all seem to forget that there is such an agreement somewhere with our name on it.  Everyone goes through the same thing, so why are we so surprised?  The reality of this truth is played out every day in my office, and on every broadcast of the evening news.


The real question is not what\’s wrong with me, it\’s how do I handle my defective self?  For the medical professional, the goal is not to fix the defectiveness, it is to help the patient through their difficulties despite their defectiveness.  People need help, not guilt-trips.  People need support, not advice.  I wish my patients wouldn\’t feel the need to apologize for being just like their doctor: defective to the core.  I wish those folks lecturing my patients would stop trying to fix other people\’s defects and remember that they are just as defective.  Doctoring is not really about saving lives; that\’s a losing battle in the end.  Doctoring is not really about restoring wellness; nobody is really well, there are just varying degrees of avoiding sickness.  Doctoring is not really about taking away people\’s pain (except maybe anesthesiologists, but living life under general anesthesia is not recommended).

I\’ve found that sympathetic helpers are far more effective than brilliant lecturers.  If I\’ve been struggling with a character defect I can\’t overcome, the last thing I want is for someone to make me feel stupid by lecturing me or giving me easy answers.  Big changes happen when people make little changes and string them together.

There\’s a guy who plays on the Atlanta Braves named Dan Uggla (think he got teased as a kid?) who was having a lousy year last year.  He had just been signed to a huge contract earlier in the year, but instead of doing the great things that were expected, he struggled.  On July 4th he was hitting .173 (below the Mendoza Line)  and talk was circulating that he would be demoted to the minor leagues.  In the next game he did something unspectacular: he got a hit.  Getting a hit is a reasonable expectation for a professional ball player, but he was not living up to expectations at all that year.  What followed was remarkable; he got a hit in every game that followed until August 12th, a span of 33 games.  Few players in history have accomplished a longer hitting streak.

Yet what had he done?  He had simply gone out and gotten a hit during a game – something he should have been doing in the first place.  He accomplished the remarkable by doing something ordinary, but doing it again and again and again.

That\’s all I want my patients to do, and all I need to do in my own life: go out and do something ordinary a lot of times in a row.  That\’s how you control diabetes, lose weight, take your medications, improve your outlook, handle addictions, and become a more balanced person.  That\’s how you accomplish the remarkable – by just doing ordinary things a whole lot.

It\’s OK.  I know you are sorry about your defects.  There is no need to apologize.  I signed the same agreement when I was born.  I\’m defective too.

Apology accepted.  Now let\’s get on with something ordinary.

10 thoughts on “Defective”

  1. Lovely.  I want to be like you as a provider and have you as a provider!Also, I sent my “Letter to an Uncaring Entity” to Kathleen Sebelius, President Obama, and my local paper (as an editorial).  Thanks again for putting it in Grand Rounds (and sorry for any confusion).

  2.  It’s actually the way that people feel.  People feel like things should be better but something went wrong with them.  Something’s missing or not working right – that’s the way it feels for them.  Using a gentler word would be out of proportion to the way people talk to me. 

  3. […] of choosing ‘unworthy’ foods.’ We would definitely be too full.  But we are ‘defective,’ as this doctor so cleverly points out.  Check it out.  That is a good article. Like this:LikeBe […]

  4. You have hit it on the nail, sir. I plan to circulate this to my partners. This really is the guts of what I address every day with my most challenging patients, not to mention myself.

  5. Power and Ambition | Karoo Publishers

    […] Defective – of Self-Destruct Buttons, Fine Print, and Hitting Streaks […]

  6. “….Go out and do something ordinary a lot of times in a row.”  So simple, yet so profound, Dr. Rob. 
    As a heart attack survivor who has had to change virtually every facet of life (diet, exercise, meds, all daily activities), I can tell you that this advice is more frequently perceived by patients as: “Go out and STOP DOING the things you really want to do!”  Friday night pizza and beer with your colleagues? Stop that. Sleeping in on Sundays instead of going to the gym?  Stop that.  Reluctant to keep taking that fistful of daily cardiac meds because of distressing side effects?  Stop that.

    For many of us, not being “defective” means the difference between what psychologists call “approach” goals (losing weight so I’ll feel and look better) to “avoidance” goals (losing weight so I don’t have another heart attack).  The latter, it seems, is doomed to perpetuate that defective label.

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