Aesthetics of change

The authors discuss a 52-year-old woman, Ms. Smith, on her third office visit to address her elevated blood pressure and obesity. With her most recent encounter, Dr. Hughey recalled that she experienced a different side of Ms. Smith. She also recalled the uncanny nature of Ms. Smith's organization of her behavior. Dr. Hughey informed the first author that her initial impressions were that Ms. Smith was noncompliant and resistant. Health care professionals often define change as linear and a logical process. They determine the best course of action for their patients, advise them accordingly, and expect them to comply. However, for many, what health care professionals see as lack of adherence to treatment plans is not resistance. It is, in fact, the patient's way of telling professionals that they have different principles by which they organize their lives and experiences. In the case of Ms. Smith, the authors learned this through the process of allowing her to tell her story. Her openness afforded new possibilities for her own care and strengthened our collaboration within their primary care. Although changes in her behavior could be explained otherwise, the authors began to wonder how their reframing of her behavior as a ritual honoring tradition helped her to actively engage in her own health care.