Item one: This weekend I replaced 600 tiny bulbs on a long strand of greenery draping the stairs in my log home. I removed three small instruction tags from each of the strands, as well as a brochure from each box, which warns in large print, SAVE THESE INSTRUCTIONS. Unlike mattress tags, it did not warn of federal penalties for unauthorized removal.

For the first time in my life – I kid you not – I read these instructions. I now have been informed, for the first time, that I should not cover the lamps with cloth or paper. There are lots of other things I shouldn’t do, too, but I won’t bore you.

Item two: A new report notes, "the nation’s office-based system of primary care doctors is ill-equipped to deal with many health needs of adolescents, particularly issues related to behavioral and developmental issues. ... The 15-minute office visit offers little chance for probing teen concerns about their bodies and what they’re doing with them.”

Item three: I just heard during a third-quarter ad break, for the 100th time, that patients using Viagra should call their doctor if they get an erection lasting longer than four hours.

Item four: Mrs. X just became the 5,000th patient in my career to ask me for a diet.

Here’s the test: What do these four items have in common?

Here’s the answer: All of them involve a quasi-religious faith in the power of education to change behavior. In fact, there is good evidence that education can increase knowledge; some evidence, over a long period of time, that it can change attitudes; and very little evidence that it can change behavior.

There are some things that our patients really, really need to know. Those essential things can get lost in a wash of irrelevant information. The perfect is truly the enemy of the good. Maybe the good is the enemy of the mediocre.

I read the instruction manual on my chain saw cover to cover. I don’t (normally) read the instruction manual for Christmas lights or toasters or lamps. It would clutter my mind, which is already cluttered enough.

I don’t probe the minds of my adolescent patients for aberrant thought patterns. I did that, some, with my five kids, and there was never much payoff. If I sense weirdness, or if a kid wants to talk, they’ll find me open, honest and non-judgmental.

I tried to find out what to do if my patient has a four-hour erection. The PDR isn’t helpful; as best I can tell, they need an emergency operation by a urologist, or something bad will happen (gangrene?). If I ever get the call, I’d probably recommend soaking in ice water.

As a rookie FP, I printed up diet plans. No more. Now I just give a quick quiz, which I’m intending to research and publish in Annals of Family Medicine. It goes like this: Which is better for you, french fries or green beans? If they choose fries, I send them to Barnes and Noble, which has 100 linear feet devoted to diet education. If they choose beans, I send them to Weight Watchers. They need a little instruction, and a lot of accountability.

Don’t throw out the baby with the bath water, now. I’m not saying education is worthless; I’m saying you have to apply it with discretion, like antibiotics. Keep your powder dry; wait till you see the whites of their eyes; discern the teachable moment. Otherwise, save your breath, and your time.

I did an internship in psychiatry. I was the behavioral science coordinator on the faculty of a family practice residency program. I’m married to one of the best teachers in my city. I started a K-12 school in 1980 that produces National Merit finalists at ten times the national average. I edited a textbook for a two-year Great Ideas seminar. I’m not cynical about the value of education, and I’m not a virgin when it comes to the bio-psycho-social approach to family medicine – or life.

Concentrate on the bio. Trust me: You’ll address more problems, do more good, waste less time and make more money.

Now let me offer some perspective on what I have written.

1. Dr. Johnson (Samuel, not an MD) observed that men more often need to be reminded than instructed. That’s something you whippersnappers should bear in mind. When you teach, act like it is a reminder. It usually is, and it is less offensive than instruction.

2. The written word is a less threatening way to teach than the spoken word, just as the spoken word to a group (a sermon or a speech) is less threatening than a one-on-one conference. So make use of handouts, or (better yet) write your own. I give new patients a whole notebook of instructions on a variety of topics, photocopied from a dot-matrix original. It’s my way of saying that most medical truths go out of date very slowly.

3. Non-physician colleagues – whose time is less valuable from a monetary standpoint, and whose training and experience has specially equipped them – will often do a better job of depth education than I can. Agencies like Weight Watchers, diabetes learning centers or local gyms may have a miserable success rate, but it’s better than mine.

4. Last week a friend died unexpectedly, and prematurely. He was one of my long-term “knuckleheads,” an affectionate term reserved for patients who have persistently refused my attempts to systematically search for, and treat, preventable conditions. He needn’t have died. Is there something I could have said, or done, to persuade him to pay attention? That’s what haunts every veteran family physician, and it tempers my advice about wasting valuable time on face-to-face instruction.