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