3 ways to bolster patients' health resolutions

Deb Beaulieu

Like many of you, I spend the better part of some days trying to change others' behavior. Although the targets of my guidance are under the age of five, many doctors I've spoken to say their efforts to persuade adults feel just as futile.

Rather than working with physicians to stop smoking, for example, 10 percent of patients will simply keep their habit a secret. From what I gather, it's not unlike when I ask my three-year-old if she's been hiding behind a chair to suck her thumb only to have her respond, "No ... um ... Did you see me?"

‘Tis the season of resolutions, as well as a potential window of opportunity where patients stop pretending their poor health habits are invisible and start acknowledging a need to make changes. To make the most of this often-fleeting motivation, keep the following three strategies in mind.

1. Identify the patient's "stage of change." In a recent issue of The Clinical Advisor, family nurse practitioner Leigh Montego said she adapts her interventions according to where a patient is in moving through the five stages of the transtheoretical model of change: precontemplation, contemplation, preparation, action and maintenance.

For patients still in the precontemplation--and most difficult--stage, she said the best approach is to focus on building rapport and building trust with the patient. Once you work your way up to the contemplation stage, patients will likely have an honest discussion about what they need to do. Still, hold off on bombarding patients with resources (e.g., lists of weight-loss or smoking-cessation programs) until they legitimately reach the planning stage of their change process. Finally, Montego wrote "your role in the last two stages, action and maintenance, is to support and encourage patients in order to help them stick with the undertaken behavior change."

Come to think of it, this is the precise process that worked in getting a certain preschooler to give up the thumb. She didn't reach "contemplation" stage until the day she sucked it raw enough to ask for a Band-Aid. When I explained that the bandage would mean she couldn't suck her thumb--and she replied that she didn't want to do it any more--I knew the iron finally was getting warm. We kept the bandage as our tool to get us through "preparation," added small rewards during "action," and used both, plus plenty of encouragement during "maintenance." We previously had attempted all of these tricks at the wrong times and failed miserably.

2. Set an example. In this month's issue of Medical Economics, family physician Elizabeth A. Pector described how her own 20-pound weight loss helped motivate her patients to improve their lifestyles. In the article, she explored similar experiences among other physicians and cited data from a small survey conducted on the physician social media network Sermo.

"Although half of the online respondents said they haven't changed their approach to patients as a result of their own wellness efforts, several doctors have found that patients bring up weight or fitness issues spontaneously in office visits when they notice the physician has changed," she wrote. "The patient's query, 'How did you lose weight?' becomes an invitation to explore the patient's motivations, goals, and potential."

Inspired by the fitness feats of some of the fellow physicians Pector interviewed for the article, she said that she wants to put her own efforts to further good use, such as by possibly volunteering for patients' charity walks and letting them raise funds through posters in her office.

For what it's worth, the aforementioned three-year old got even more motivated to kick the thumb habit after being told her dad would try to quit biting his fingernails (though no one has technically verified the validity of that claim).

3. Consider sharing your notes. Finally, a post in National Public Radio's Shots blog argued that patients participating in Massachusetts' OpenNotes project may take their physicians' advice more seriously when seeing opinions and facts about their health in black and white.

According to Jan Walker, a nurse at Beth Israel Deaconess Medical Center in Boston and lead author of the OpenNotes study, "a notation describing a patient as 'obese,' for example, may be much more effective than a physician's verbal instruction to lose weight at bringing home the seriousness of a problem and the need to do something about it."

Further, Walker asserted that seeing the doctor's notes can help remind a patient about what was said during a visit in which they may have been distracted by anxiety. And if patients share the notes with caregivers, friends or family members, they can potentially have that much more support from individuals who understand the patient's real health circumstances.

These are just three potential ideas for affecting behavior change pulled from recent health stories. Have you tried any of these techniques to get patients to improve their health? Any other suggestions for your peers? - Deb @PracticeMgt