ONE OF MY patients, a well-groomed man in his mid-50s, always showed up in my office on time and prepared. This was how he approached everything. He tracked his workouts, his sleep stages, and his protein intake. He managed stress with cold-water plunges at dawn. He prided himself on his fitness, telling me as he sat down across from me that his trainer told him he was “healthier than most 20-year-olds.”
So I thought hard about how to approach the conversation about his cholesterol levels. They didn’t match his disciplined lifestyle, which meant that telling him that he was at high risk for a heart attack and stroke would be hard for him to digest. His labs showed a persistently high LDL cholesterol level in the 150s and an extremely high lipoprotein(a), a genetically determined cholesterol particle that cardiology experts now recommend checking once in a lifetime. LDL levels are dynamic—they can improve with diet and exercise. But the lipoprotein(a) level doesn’t move no matter how many miles you run, walk, or swim. Patients like this one keep trying anyway.
With his family history of premature heart attack (his dad died in his 60s from one), I suggested a coronary calcium scan to look for plaque in the arteries. He waved it off. “I can’t imagine I have heart disease. I just ran a half-marathon and I’m nothing like my dad.” I appealed to his competitive nature and insisted, saying, “I’d love you to prove me wrong,” and he agreed to the scan. I called him two weeks later and told him it showed significant plaque in his coronary arteries.
It was then that my patient realized this hard truth: optimizing isn’t the same as health. Tracking more data doesn’t protect you from medical vulnerability. Willpower isn’t sufficient for healthy outcomes. For years, my patient had absorbed the message that the most important thing you can do for your health is more discipline. But after 25 years of practicing medicine, I can tell you that habits matter—they really do—but that the most important thing you can do for your health is get curious about the elements of your health that are quietly developing despite your best efforts. Health isn’t about having all the answers; it’s about asking better questions—of yourself and the people responsible for your care.
Patients come in all the time with solutions—requests for GLP-1s, testosterone therapy, an order for a full-body MRI—but I always stop them and make sure what they’re asking for would solve the problems they actually have. Because sometimes you don’t need a GLP-1 for metabolic health; you need more hours of sleep. Sometimes you don’t need testosterone for libido; you need relationship counseling. Sometimes you don’t need an MRI; you need help managing health anxiety.
Doctors often don’t have enough time to surface the question beneath the question. To dive into the details of your everyday life. To help you know where you have control and where you need to cede it. So it’s more important than ever to pause and take stock of your specific needs—and to generate more specific questions—to make the best use of that 15-minute appointment.
So start with yourself. Before you reach for a solution—a diet plan, a test, a new tracker—ask yourself: “What am I actually solving for?” My patient had been answering the question “How do I stay healthy for life?” for a decade. But exercise was only part of the answer. The question that needed posing was different: “What are my fixed risk factors for cardiovascular disease—the ones I can’t exercise my way out of?”
Next, bring sharper questions to your doctor. Most of us walk in with a solution disguised as a question. I suggest reframing questions like Should I get the full-body MRI? Should I take testosterone? A GLP-1? to generate a conversation (and not just a yes/no). For example: What are the risks and limitations of this for me—given my history, my genetics, my real life? One version asks your doctor to confirm a decision you’ve already made. The other invites a conversation about you—your vulnerabilities, your needs, your goals.
Last, communicate your goals, needs, and fears to your doctor. Demonstrating self-awareness goes a long way in the doctor’s office. Acknowledging your attitudes toward health, your tolerance for risk, and your vulnerabilities helps your doctor understand you and meet you where you are. It also builds trust. You can help your doctor help you by saying things like “I tend to struggle with gray areas” or “I have a hard time accepting things I can’t control” or “I tend to minimize symptoms.”
None of this is an argument against effort. My patient needed to keep every one of his habits. He also needed a statin, a cardiac stress test, and permission to be human. Health is not a contest between willpower and medicine. It’s both. As for my patient: he’s still running. He’s also still trying to prove me wrong—and I’m rooting for him all the way to the finish line.
Lucy McBride, MD, is a primary care physician in Washington, DC, where she has practiced for 25 years. She is the author of Beyond the Prescription: A Doctor’s Guide to Taking Charge of Your Health.
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