Nature is a bad teacher. 1/

She teaches with punishment. Not positive reinforcement. 2/

Don’t take your insulin, lose a leg.
Don’t take your blood pressure meds, have a stroke.
Skip your Plavix, have another heart attack.

Well-trained dogs don’t learn by beating.
The best dog trainers carry treats, not a whip. 3/

We make a bad mistake in the medical field by adopting Nature’s poor teaching technique. 4/

Trying to “warn” or “scare” patients of the beating they will receive if they don’t do what we want doesn’t teach much better than the beating itself. 5/

You have to ignore Nature and her affinity for punishment in her classroom. 6/

Instead, use science. 7/

People who train mammals from dogs to killer whales will tell you, there is only one way to teach.

Reward the behavior you want to see more. 8/

That doesn’t always ring true to doctors. We are a damaged crew. Most of us were raised as I was by parents who taught us to behave out of fear of punishment. 9/

Get good grades or you’ll be a failure.
Find a good career or you’ll be poor.
Smile and shine so you’ll get chosen. The ones who aren’t chosen are sad and resentful. 10/

When you have parents who use the whip more than the treat, you don’t learn how to teach. You only learn how to fear.

Fear might keep you out of jail but it doesn’t guide you to a warm, fulfilling life of mutual benefit with your tribe. 11/

Nature’s not going to change. She is ruthless and unforgiving.

She is also inconsistent and unjust. Most people get sick by no clear fault of their own. 12/

Accept her as she is. She has many other fine characteristics as well.

Don’t learn her methods. Learn the scientific methods that work with patients acknowledging the universal commonality of the mammalian brain. 13/

When you see the good, reward the good right there with praise.

Don’t dwell on the past or rub their nose in their mistakes. The opportunity to teach only exists in the present. 14/

For the most part, behavior you want to see less is best ignored. We pack animals hate to be ignored. It’s cold and dry.

In contrast, attention is the reward we seek. 15/

Learn from your dogs and your kids. Beyond the basics of survival all the mammal wants is to be accepted and welcomed into the warm fold of the pack. Appreciated just for being and offered an opportunity to try again, supported. 16/

Avoid the temptation to view your patients like a 4H livestock display.

You don’t get a blue ribbon for the A1C of 6.2. You don’t lose points for the >15. The patients are living their own life. You are just here to offer suggestions. 17/

Don’t worry about your reputation. Try to learn to be effective. 18/

Curiously, the better you get at changing behavior (patients & students too) the more “popular” you will become.

Rewards, inclusion, and appreciation are the warmth and safety we all seek. Generate that and you’ll make things better for yourself and the people around you. 18/