Doctors often admonish their patients to make lifestyle changes that will help their health: stop smoking, eat better, exercise more and lose weight.
If patients don’t make progress on these challenging goals, doctors may get frustrated and scold patients. Then they prescribe pills to lower cholesterol, control blood sugar or reduce blood pressure.
Patients also feel frustrated. Making big changes can be extremely difficult. People get defensive when they are scolded and may give up.
Einstein supposedly said, “Insanity is doing the same thing over and over again, but expecting different results.” We know doctors are not crazy, but the pattern of reprimanding and prescribing is repeated over and over.
As any parent who has ever tried to nag a child into keeping his room neat knows, scolding doesn’t work very well. A new approach, known as motivational interviewing, is gathering momentum in medicine.
Those who have been trained in its use learn to collaborate with patients. They find out what goals the patient is setting or willing to set, and then help the patient figure out how to reach them. This may mean tackling baby steps or finding rewards that are meaningful to the patient.
Behavioral economist Dan Ariely, PhD, tells in his superb book, Predictably Irrational, of being prescribed a medication that had horrible side effects. It was essential for treating a very serious viral infection.
He was supposed to take it three times a week. Because he loves movies, on treatment days he would rent a movie, set up everything for comfortable watching and then take the medicine. By the time he began to experience the fever, headaches, nausea and vomiting, he had already enjoyed much of the movie and was able to look forward to the next movie hit. He was the only patient in the study who managed to take every dose as the physicians recommended.
Dr. Ariely explains his strategy, “Planning my evening in this way helped my brain associate the injection more closely with the movie than with the fever, chills, and vomiting, and thus, I was able to continue the treatment.”
As you might guess, rewards need to be individually tailored. Goals also need to be personalized. Rather than being told, “You must lose 50 pounds,” the person decides what goal has meaning for her. She and the doctor, nurse or health coach figure out together what steps she needs to take to reach it. Then the coach uses nonjudgmental encouragement to follow up at each step. This adds the dimension of accountability, critical in maintaining progress.
Physicians often complain that patients stop taking their medicine. Sometimes they don’t even fill the initial prescription, suggesting that patient and physician were not on the same page about the benefits and risks of the drug. Doctor visits may be too short for the doctor to ask the patient what he thinks about the medicine.
In a different approach, the patient’s concerns about drug side effects could provide an incentive for him to change his diet and exercise patterns. The goal would be to reach an acceptable blood pressure, for example, without medication. Being congratulated instead of scolded would be a welcome change for many patients.
