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Tending to Our Gardens in Times of Dismay: On Behavioral Prescriptions

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A few months ago, I had a patient who was suffering from a depression brought on by circumstances she couldn’t control. So paralyzed was she by the magnitude of situations that she could not change that everything had lost its meaning. Prior to this moment, my patient had been an avid gardener, but now she had sat staring at her broccoli seeds for months without an ounce of motivation to plant them. For her, the sun shone on empty, untilled soil. 

When patients come in feeling stuck, I often turn to those things that are within their — and my — control. Thus, though I knew that what I was about to tell this patient wasn’t what she hoped to hear, I felt that it might nonetheless abate her dismay: I offered her the behavioral prescription: Today, plant your broccoli seeds. 

During our appointment, this patient and I talked about the spot she had in mind in her garden. The next step was actually planting them. She received the “prescription” to plant her broccoli seeds willingly, and, to my surprise, by the end of my workday, I had received a message from her that stated, “Followed doc’s orders and planted my broccoli seeds.” 

Cut to a few months later. At our most recent appointment, this patient reported that not only had she planted her broccoli seeds, she had planted many types of seeds, which had grown into a beautiful vegetable garden. External stressors of her life were still not much different, but her garden was, and, though I’m not sure if she realized it, she was different as well. There was joy in her countenance as she described how her garden was thriving with all of the new types of vegetables she had planted. She had returned to respite, a sacred place, and a tiny piece of joy that she had some level of control over. She could tend to her garden and take care of it and see it flourish even if there was decay in other areas, and she could return to her garden when life was hard. 

For me, seeing the fruits of this behavioral “prescription” was refreshing — a reminder, even, of what I love about being a physician. I find that engaging patients (and even ourselves!) in behavioral modification is one of the most challenging aspects of medicine. Sometimes the limitations of conventional medicine, and the refusal of patients to engage in therapeutic behaviors, can leave me feeling helpless — if I’m being honest, it doesn’t always go as well as it did with my gardener patient. But when it does go well, it’s motivation for me to keep trying, whether something comes of it or not. 

As doctors, we naturally want to help people, but oftentimes we become so bogged down in the details, the workup, the severity of the illness, the feelings of helplessness when our patients aren’t getting better, and the administrative hurdles, that we can sometimes forget that at the end of the day, it has always been about the person in front of us, the human-to-human encounter. I’m reminded through this patient success story that the work that we do with patients matters. When we (metaphorically) plant seeds for our patients — whether that’s a kind word, instilling hope, or engaging patients in setting small goals — we can have a profound impact on their lives and well-being, even if the “prescription” looks inconsequential. 

For my gardener patient, those simple (literal) seeds turned not only into a vegetable garden but also increased resilience, empowerment, and the knowledge that despite what’s going on in our lives, the small choices we make matter. We can have a bad day and plant our seeds and grow our garden. We can feel lonely and plant our seeds and grow our garden. When nothing seems to be going right, we can still plant our seeds and grow our garden. 

Over time, I have been able to successfully apply behavioral prescriptions to various patients in my practice in combination with conventional treatment as indicated. Through these prescriptions, I have been able to engage my patients in more meaningful parts of their lives and connect them to what authentically brings them joy. Successful implementation of behavioral prescriptions reinforces that I can help my patients do difficult things and that they can start taking back their lives one step at a time. Some of the changes I have witnessed in individual patients include: growing a vegetable garden, creating a room for their crafts and starting to craft again, increasing their physical activity, and creating a daily self-care routine. I hope to one day have many more examples. As one of my patients recently stated after they successfully began working on a project they had neglected for many months, “It’s something small, but it helped so much.” 

My fellow clinicians, I encourage you to consider implementing behavioral prescriptions in your practice and take a few extra minutes to “plant the seeds.” You never know what could grow. 

Are there “seeds” in your own life that you’ve been wanting to plant but for whatever reason haven’t? With some of your patients, is there a behavioral or lifestyle prescription that can help give them some momentum toward larger changes? Share in the comments!

Dr. Mallory Grove is a psychiatrist in Seattle, WA. In her spare time, you can find her enjoying time with her family, thrifting, adding to her houseplant collection, baking, playing her flute, or learning to sew. Dr. Grove is a 2023–2024 Doximity Op-Med Fellow.

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