Medscape just published an article titled “For Noncompliant Patients, a Fix That Works”. I often read posts on this website, to stay informed of the latest medical breakthroughs, treatments, and health issues and feel they are one of the most credible and informative sources out there on the web today. I have several chronic health challenges, not the least of which is being an ashamed educated smoker…..which surely complicates all the other health problems I have as well as being a problem on its own. Addiction is a tricky thing. I have tried without success yet several times to quit smoking, so in this respect I suppose I am a noncompliant patient……which made the article piqué my curiosity.
Many doctors over the years have approached the topic of quitting smoking with me. The talk usually goes like this: “Well,are you still smoking?”. Yes I say. “You are slowing your body’s healing process and constricting your blood vessels by continuing this. You need to quit.” I know I say to myself silently, as my eyes lower their gaze towards the floor. “Here, take this pamphlet. There is a quitline phone number on the back of it to give you options on how to quit. So, how is your pain today?” And the discussion ends just like that. Now don’t get me wrong…..it is certainly not the doctors fault that I haven’t been successful at quitting yet, only mine. It is noteworthy though that this is typical of most doctor patient conversations of this type.
This article recognizes that many patient noncompliance discussions are just not done in the ideal way. Whether it is an issue like mine, or taking lifesaving medicine as directed, or changing other lifestyle habits that directly impact health and mortality there is an overall sense of frustration. Enter a new approach that doctors can take with their patients…..it’s called motivational interviewing. I quote from the article: “A growing number of doctors have been using a special technique that gets superior compliance from patients….. It’s a way of talking with patients that’s designed to elicit their barriers to compliance and assist them in overcoming those barriers. Studies show that doctors using this method of interaction can often work wonders. ” So what is motivational interviewing, you ask?
At first glance, I thought perhaps this was some new conversational technique that had just been discovered and unleashed upon the medical community with astonishing results. Then I read the entire article. Well, it turns out that motivational interviewing is exactly what the specialty doctors I trust the most, and feel are truly integral in my support, have done all along. In a nutshell, its demonstrating genuine empathy for the patient. The “technique” as described involves partnering with the patient, asking positive open-ended questions to stimulate a dialog, using scales to encourage patient interaction, and planting the seeds of change. Funny that I would assume most of these would be commonplace, yet my experience has shown the opposite. I have a handful of phenomenal doctors that I consider key members of my “team”, and I went through dozens more before I landed in the office of these gems. Looking back now I see the one thing that makes these doctors different…..keepers if you will….from the others that I chose not to continue treating with. They all have empathy. Each one of them makes me feel like they take a genuine interest in ME. With these docs, I don’t feel a number or a chart or worse yet…..a paycheck. Yep, what sets them apart and makes them stellar in my eyes is their authenticity when they say they really care about me…..it shows. And the proof that this technique actually works? I am after all still struggling with smoking…..a fact that these specialists don’t typically address with me. Well to me the proof is that after a decade of despair, uncontrolled pain, and a general tumbling down into the rabbit hole I found this team and have made remarkable progress in recovery and general everyday functioning in the world. Although I still have scary issues that arise, I am doing so much better in the last couple years than anyone could have imagined. That is my definition of success. As the article states, doctors can get the ball rolling in less than five minutes during a visit because most change happens incrementally over time. And that is the key in my mind…..a general chipping away of old patterns to be replaced with new through caring conversations and gentle reminders, always reinforcing the goal. So it’s not really the message that doctors are delivering that makes the difference. It is, in fact, HOW the message is delivered that works these wonders. Imagine that.