A discussion on behavior change ( Part I )

I had a very interesting discussion with a frustrated resident. After dealing with a difficult patient with multiple chronic diseases, he expressed frustration about patients that don't follow through with our recommendations. He took a big step in identifying some of the problems in how we counsel patients. 

 When we see a patient we are quick (and good) at pointing out all the bad things that could happen if a behavior change isn't adopted. 

   ”If we don't do a better job controlling your diabetes, X, Y and Z could happen." 

This is what our current training in medicine advocates. Our education revolves around the diseased state, how to treat it, how to cure it and to a lesser degree, how to prevent it. And when we talk about prevention, the motivation is based on what the physician values. In this case the physician values the”X, Y & Z" outcomes, but patients may not put as much stock in that. 

The resident suggested shifting motivation to what the patient values. 

  “If we do a better job controlling your diabetes, you will feel better." 

“If we do a better job controlling your diabetes, you are more likely to make it to your grandson's wedding."

This was terrific insight from a young, inexperienced doctor. And with that, he touched on one of the sentinel questions in modern medicine. What is the best way to enact behavior change in medicine?

There are several elements to it. The most fundamental prerequisite is to know your patients well and what they value. By understanding what they value, we can tailor behavioral change advice that is meaningful on a personal level and therefore more likely to succeed. This is a fundamental concept in how we should be practicing medicine. It is also a concept we don't emphasize enough in medical school and residency training. 

My discussion with the resident carried on much further. In subsequent parts, I'll share some of the  technical aspects of behavior change that we discussed and how to incorporate it in modern medicine.