Most of us have been there. We have delivered sound and tested health advice to our patients but the patients just won’t listen. We tell them again, still to no avail. Frustration sets in and we ask ourselves why the he** they come to us in the first place when they won’t do what we tell them to.
It’s not that these patients are stupid by any means. Many of them are really smart and successful. They might even have a university degree, drive expensive cars, live in beautiful houses etc. So most of them know the art of setting goals and achieving them. So what’s the problem we are facing here? We think that the whole health-communication paradigm is broken. Why? Becaus health itself is a misnomer and in this post we are going to tell you why.
What is “health” to most people? If you ask your patients, they will come up with a sentence that sounds something like “not being sick”, “not being in the hospital”, “feeling good without disease” etc. So essentially to them, health is the absence of disease (we know the WHO and other entities have a different definition of health but they just have not told our patients yet). When patients hear “health”, they can’t help but think of “disease” at the same time. It’s like if I told you not to think of a pink elephant. You get the point?
So what happens in the patient’s brain when you give her health advice? She will say to herself “These are steps I can take to avoid a certain diesease or complication in the future.” Now why is that bad? Becaus it’s what we call an avoidance goal. Psychologists have found that avoidance goals are much less effective than approach goals (i.e., desireable goals like wealth, success, happiness etc.). So the patient’s definition of health as the absence of disease counteracts all our preventive measures.
Imagine the following situation: Your daughter of 6 has prepared for a skiing race. It’s 5 minutes before the start. You want to give her some important piece of advice. Which one of two messages are you going to use?
1. “Honey, don’t forget to do XYZ, it will help you avoid loosing.”
OR
2. “Honey, don’t forget to do XYZ, it will make you faster and you will do really good.”
Now we have tested this choice with several people and everyone chose answer #2. Why? Because it’s way more encouraging. It’s an approach goal and approach goals rock. Our problem as physicians is that we are constantly sending out avoidance messages to our patients and this has been proven to be much less effective.
What’s the way out of this conundrum? We won’t be able to change the definition of health in our patients’ heads, that’s for sure. So we have to introduce a new entity…
Wellbeing enters the stage.
We have to communicate to our patients the concept of wellbeing or wellness (we think that “fitness” has too much of a sporty touch). Your personal wellbeing is a continuum between death, disease, health, wellbeing and perfect wellbeing. It is not a dichotomy. We and the patients have to realize that we are not either healthy or diseased. You might have the genetic predisposition for disease XYZ already, the disease just has not manifested itself but it’s just a question of when the disease will break out (i.e., when your 55 or 85). Are you healthy or diseased then? It does not matter. We all have our sets of risk factors and protective factors. We are all on a continuum and we have to strive for optimal wellbeing.
Want to advance to an approach mentality with your patients? Here are some steps you can take next time you talk to a patient:
1. Ask the patient what her goals are in life. If she does not answer with “happiness”, drill down and ask “why is that important”. So for example when she says that she strives for money. Ask her why that is important. Then ask why again. Most people will come up with something like “because I think that XYZ will make me happy” at the end.
2. So if you have established happiness as a deliberate goal together with the patient, ask her if she thinks that wellbeing has any bearance on her happiness. Anyone who can reason will answer “yes” to that question.
3. Ask her if she would like you to tell her some (easy and) important steps that will boost her wellbeing in the close future and then get her commitment to follow these steps.
We have used these steps on our patients and we have shared the method with colleagues. We got great feedback. You might want to tweak it a little bit to your needs and personality. Try it out and tell us your experience in the comments.
