Monday, April 19, 2010

Clinical Decision Making: Heart, Mind and Brain

"As a man thinketh, in his heart, so is he."... The Bible

As a family physician, I see many people with a wide variety of symptoms, often undifferentiated with regard to a specific or obvious diagnosis. In these circumstances, I establish a differential diagnosis (list of possible diagnoses that might cause the main complaints) and seek to clarify, in partnership with my patient, what direction to pursue for diagnostic and/ or therapeutic strategies. If the symptoms and physical findings don't align with specific diagnoses, I further clarify with the patient what the symptoms prevent them from being, doing or having. It's also helpful to clarify the patient's misalignment with life goals and dreams as a result of the symptoms. I might ask, "When is the last time you were yourself?" As the misalignment is clarified, we review ways the patient might realign with their life direction.

Often, people are blocked from taking the ideal path to realignment with themselves by a limiting belief. "I always get bronchitis when I get an upper respiratory infection." "What's the use in following the diet and exercise plan, I know that eventually I'll have my legs cut off like my grandpa now that I have diabetes." "If I disagree with my mother about the need for her to get a home care nurse, she'll give me the 'look' and I'll freeze up again." "If I don't go to the ER when I get the chest pain, it might finally be the heart instead of the gastroesophageal reflux." "My friend took Chantix to quit smoking and got a serious depression. I don't want any part of that stuff." Many other limiting beliefs derail people's desire to be whole, challenging the family physician to be a "belief change agent".

The limiting belief is usually in the brain, so I may remind my patient that the brain is a simple filing system that can be changed by the mind which may be more creative and flexible. "You can imagineer your way to a new belief with your mind. Imagine a future in which you see, feel or hear a different reality for yourself."
"See yourself at your daughter's wedding." "Feel the sand between your toes at the beach." "Smell the breeze at the beach." "Hear the music of your church choir." "Feel the strength in your legs as you walk your dog on a spring day in your neighborhood."

Some patients can allow their heart to overcome their brain's limitations via the Quick Coherence Technique developed by Heartmath (at This entails getting a heart focus and "breathing" through the heart area and appreciating through the heart area. After establishing Coherence (geeks may wish to buy their software and ear sensor to demonstrate through analysis of heart rate variability a balance between sympathetic and parasympathetic nervous systems), the patient can inquire of their heart center as to what to do to change the limiting belief or what alternative action to pursue. This is a hard science way to clarify what may previously have been seen as a holistic or religious approach to problem solving or "integration" of mind, brain and heart.

Through Heart or mind or brain or a combination of two or three of them, family physicians may help patients to change limiting beliefs that impair the patient's ability to align with their ideal health strategies. Positive belief alignment may lead to better health alignment and better life alignment. Medical outcomes such as Hgb A1C, BP, Lipids, etc. may be more achievable as the patient learns to overcome limiting beliefs.


  1. Helena Duque-PagesApril 22, 2010 at 10:26 AM

    Dear Dr Synonimus: Good pearls...Looking for more insightful columns.

  2. Right on, brother. I couldn't agree with you more.