A Change of Perspective

Written by Dr. Charles Edwards

I recently read the book entitled Switch: How to Change Things When Change Is Hard, written by brothers Chip and Dan Heath. At first I was dismissive and (self-righteously) thought the authors should meet our Memory Center families if they wanted to catch a glimpse of people being faced with true hard life changes. As I continued reading, however, I began to see how adopting the authors’ view of “change” could improve my interactions with caregivers, resulting in better patient care.

One example from the book that helped me reframe my interactions with families discussed a problem at the McDonald’s Corporation. Sales of fish sandwiches were down. Numerous resources and personnel were assigned to study the issue and develop strategies to increase sales of fish sandwiches. The efforts paid off, fish sandwich sales did improve, but an unintended consequence was noted –hamburger sales suffered. McDonald’s concentration on what was not working, fish sandwich sales, hurt the company’s core successful product, hamburgers.

You may be asking yourself what fast food has to do with caring for patients with Alzheimer’s disease and other types of dementia. Often, when a family comes for an appointment to discuss their loved one’s memory loss or behavior challenges, we spend much of the visit discussing what is not working (similar to the fish sandwich problem at McDonald’s). My goal has been to provide effective solutions to help families reduce these hurdles. I learned that I should change my perspective and ask caregivers what IS working. In other words, why are the figurative hamburgers sales going through the roof? Identifying the daily or weekly moments that allow the patient to be happy, content, calm, engaged, and peaceful shows us what works. Adding more of these “hamburgers” to daily life will have a positive impact. We also examine what gives the caregiver a sense of joy, rest, patience, renewal – and encourage them to do one thing on this list every day.

This new focus has allowed my team and I to identify countless creative strategies that actually work, which is much more effective in helping our patients and families. Assessing a patient’s cognitive and behavioral challenges is a key part of our job, but figuring out what works for each unique patient and family situation, makes me a better physician and makes us a better team. The first time I asked a patient’s wife, “What IS working”, she replied, “That’s easy. Watching basketball and drinking beer is the best part of our day. My husband can no longer follow the subtleties of the game but he still loves watching.” She then smiled, “The beer is for me.”

Caring for loved ones with dementia is difficult and demanding. Our minds naturally tend to catalogue the seemingly insurmountable hurdles. It’s time to turn the focus to the “hamburgers”, identify what IS working, rather than trying to fix what is not.


  1. Julie Bigham on December 13, 2017 at 2:27 am

    Awesome! I love positive outcomes, from the purposefully positive focus!

  2. Joedon on January 9, 2020 at 3:54 pm

    So when concentrating on what is working and using that as a positive approach, what is done about what is NOT working?