Cut From Steel

He was given one chance in five hundred and took over

Norman Cousins edited the Saturday Review for thirty years and took its circulation from 20,000 readers to 650,000.

In 1964 he fell seriously ill with a connective tissue disease, later described as ankylosing spondylitis. His doctors told him he had one chance in 500 of recovery.

Cousins then did something almost nobody did in 1964. He moved out of the hospital, worked out a plan with a doctor willing to try it, and took an active part in his own treatment instead of waiting to be treated.

The plan involved high-dose intravenous vitamin C and a deliberate programme of comedy films. Cousins reported that ten minutes of genuine belly laughter bought him at least two hours of pain-free sleep.

I have to be straight with you about the medicine. Doctors have argued about this case ever since, and one entirely plausible reading is that he had an acute episode which then subsided on its own, slowly but naturally. Nobody has demonstrated that laughter cured Norman Cousins of anything.

He wrote the whole thing up in 1979 as Anatomy of an Illness, and he lived until 1990. What he changed was not the treatment. It was who was in the room making decisions. That part you can copy on Monday morning.

You get one appointment and you waste the first half of it

You sat down, the doctor asked what brought you in, and you heard yourself say you had been feeling tired lately. Twelve minutes later you were in the car park holding a leaflet and no plan.

I want to fix the input rather than complain about the doctor. The Agency for Healthcare Research and Quality, which is the United States federal body for precisely this problem, runs an entire programme on the questions patients ought to be asking.

You are allowed to walk into that room holding a piece of paper.

It's not age. It's these three.

I will give you three moves that change what comes out of a short appointment.

01 / Bring Three Questions, In Order

AHRQ's advice is to start by asking the ones that are most important to you. Three is the number that survives a short appointment intact. Write them on paper rather than a phone, put the one that frightens you at the top, and hand the list across at the beginning rather than fishing for it as you stand up.

02 / Say It Back Before You Leave

AHRQ tells patients that if they do not understand or are confused, they should ask the doctor to explain the answer again. The stronger version of that is to repeat it back in your own words while you are still in the chair. Whatever you cannot repeat, you did not understand, and you certainly will not reconstruct it in the car.

03 / Ask What The Test Is Actually For

AHRQ's own sample questions include what a test is for, what the treatment options are, what the benefits of each option are, and what the side effects are. Those four are unglamorous and they are the ones that change decisions. Ask them out loud even when you are fairly sure you already know the answers.

Take it back today

I owe your doctor some fairness here. Most of them are working inside appointment lengths they did not choose and cannot change, and a prepared patient makes the job easier rather than harder. Almost none of them will resent a list.

You should bring somebody with you to the serious ones. AHRQ suggests it plainly... another person helps you understand and remember what you heard, and a second memory of a difficult conversation turns out to be worth a great deal six weeks later.

I want you to write the three questions today, even if the appointment is a month away. Fold the paper into your wallet and leave it there. A question written on a calm Saturday morning beats anything you will invent under a fluorescent light with your shirt off.

You have been walking into these rooms empty-handed and hoping to be asked the right thing. Three questions, on paper, in your wallet before tonight. That is the entire assignment.

— Travis

Insider Member's Corner

6 free habits for a better appointment:

Saturday money is for the things that make an ordinary evening deliberate.

01 / Case · A cedar-lined humidor

Spanish cedar, a decent hygrometer, and the humidity held somewhere around 65 to 70 percent. The box is not really about storage. It is about a man having one small ritual in the house that takes ten unhurried minutes and belongs to nobody else. Buy a modest one and fill it slowly rather than buying a large one and filling it in an afternoon.

02 / Coat · Belstaff Trialmaster

Waxed cotton, four bellows pockets, a belt, and a design that goes back to the motorcycle trials riders of the late 1940s. It is heavy, it smells faintly of wax in the rain, and it will look correct on a man of 58 in a way that almost no modern jacket manages. Re-wax it every couple of years and it becomes genuinely yours.

03 / Glass · The Sazerac

Rye whiskey, a sugar cube, Peychaud's bitters, and a chilled glass rinsed with absinthe and the excess thrown away. Lemon peel expressed over the top, then discarded. It is New Orleans in a small heavy glass and it is one of the oldest cocktails anybody still makes properly. Learn to build one and you will never need to order badly again.