Motivating any kind of patient is not easy. Helping chronic care patients become autonomous requires you to convince them to take charge and adopt healthy behaviors on their own in the long run. How can you possibly manage that without constant supervision?
The genuine drive comes from inside, but as a physician you can set the motivational process in motion, employing a variety of methods we’ve outlined below for your convenience.
Emphasize Patient Outlook
Focusing on the patient perspective is easier said than done, naturally. How can you motivate a patient to engage in behaviors that he or she simply doesn’t want to do? And we know engagement is preferable to compliance-based care, but it’s also more difficult to attain.
You can begin by focusing on a patient’s intrinsic motivations, rather than deal with the desire for rewards or aversion to negative feedback. There are triggers you can employ to get patients concentrating on their intrinsic selves, such as open-ended questions, asserting yourself to the patient, and demonstrating that you’re listening.
In a 2006 study titled “Motivating Patients with Chronic Diseases,” Dr. Alain Golay and his team stress the importance of highlighting a patient’s interior life, stating that the “caregiver can only provoke a change in patients’ behavior if he/she approaches them with a fresh perspective, centered on considering them as individuals.”
During a session on motivating diabetic patients at the World Diabetes Congress, NHS pediatric psychologist Deborah Christie outlined key questions you can use to identify how someone may be ready for change:
How important is it that you change?
How confident are you that you could succeed?
How much of a priority is this change for you?
As a physician, it becomes your duty to recognize that engagement is a patient’s choice alone, because people care about their own reasons. If you’re unhappy with how any of the questions above were answered, you’ll have to turn to more proactive methods to motivate your chronic care patient.
Before applying any sort of rigid methodology to motivate your patients, you must remember the importance of the human relationship dimension for pushing motivational change in patients. Dr. Patrick G. O’Malley recognizes the need for doctors to do this more often in an article for Physicians Weekly.
“The goal should be to have […] physicians become competent communicators,” said Dr. O’Malley. “A paradigm shift in prioritizing and incentivizing better communication in the context of patient-centered care is needed.”
And while there is a lack of academic studies on the matter, simply recognizing the need for enhanced human interaction already places you a step ahead of most other physicians. But there are still more specific things you can do to help a patient in need.
For one, always remember how you frame questions. Don’t ask why a patient forgot that he skipped a dosage or are why he’s doing worse overall. Instead, ask what he was doing when he was feeling well and optimistic. Try expounding on what works for the patient.
Think of what would make coming to your practice worthwhile for a patient, and, by extension, what keeps him coming. Use a patient’s answers to zero in on treatment goals, and get more profound with questions like “where are you now?” and “where would be good enough?”
This kind of motivational interviewing helps you empower chronic care patients, giving them the idea that they still have control over their fate.
What kind of approach do you take towards chronic care patients?