Behavior change/motivation in FM

[loveoforganic]

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I'm a premed, and one of my interests in medicine is FM, and a large part of this interest stems from my interest in facilitating behavior change in patients (tx adherence, diet/exercise, drug use, etc.). From what I've seen/read, this generally seems to be a frustrating aspect of the field to most FM docs. This makes sense, obviously, since facilitating change isn't easy. However, I've never really heard it voiced in a positive light. Do any of you derive much satisfaction from this aspect of practice?

TYIA 🙂

 

[VA Hopeful Dr]

I'm a premed, and one of my interests in medicine is FM, and a large part of this interest stems from my interest in facilitating behavior change in patients (tx adherence, diet/exercise, drug use, etc.). From what I've seen/read, this generally seems to be a frustrating aspect of the field to most FM docs. This makes sense, obviously, since facilitating change isn't easy. However, I've never really heard it voiced in a positive light. Do any of you derive much satisfaction from this aspect of practice?

TYIA 🙂

Its a nice feeling when its successful. Sadly, that is fairly rare in most circumstances.

 

[smq123]

I'm a premed, and one of my interests in medicine is FM, and a large part of this interest stems from my interest in facilitating behavior change in patients (tx adherence, diet/exercise, drug use, etc.). From what I've seen/read, this generally seems to be a frustrating aspect of the field to most FM docs. This makes sense, obviously, since facilitating change isn't easy. However, I've never really heard it voiced in a positive light. Do any of you derive much satisfaction from this aspect of practice?

This is a frustrating aspect of MEDICINE to almost ALL doctors.

Patients who refuse to change their behaviors is something you will encounter in almost all fields of medicine, aside from, maybe, anesthesiology, pathology, and radiology.

On your OB/gyn rotation, you will see young women who don't "feel like" taking birth control....and end up pregnant over and over and over again. Or end up with chlamydia for the 4th time.

On your IM rotation, you may see endocrinologists battling with diabetics who refuse to measure their blood sugars and don't take their medications/insulin, or cardiologists who fight with patients about their high cholesterol. Pulmonologists have many patients who still smoke every day, despite having bad emphysema.

On surgery, you will see vascular surgeons who have had to operate numerous times on the same patient - because the patient didn't change their behaviors, their peripheral vascular disease got worse.

And if you think that peds is safe from this - one of the most frustrating encounters I remember was with a father who insisted that his chain-smoking had NOTHING to do with his child's severe asthma. 🙄

 

[loveoforganic]

I definitely agree that it isn't limited to FM - I wasn't clear about why FM in particular got my interest over another field like you mentioned. I think in FM you'd see a higher percentage of patients who you have the opportunity to counsel before they get to the point of needing that specialist care, e.g. obese teen who is only at risk for type ii diabetes. As far as FM vs peds vs OB, peds definitely lies in the same territory, and definitely isn't off my map of interest. Just don't know about how important diversity of patient population is to me, and won't know that for another 3 or 4 years. OB same territory too, by and large, buy no thank you 🙂

Its a nice feeling when its successful. Sadly, that is fairly rare in most circumstances.

But do you enjoy the process of trying to reason through how best to try to change the behavior, before you see the results?

Thanks for your replies.

 

[VA Hopeful Dr]

But do you enjoy the process of trying to reason through how best to try to change the behavior, before you see the results?

Thanks for your replies.

If you mean from start to finish (pre-contemplative, contemplative, and so on), with motivational interviewing and what not... then no. That's too much stuff with too much variability that still fails quite often.

I prefer helping patients who want to modify their behavior or ones that I can convince that they need to within the confines of a handful of office visits.

 

[MJB]

This is a frustrating aspect of MEDICINE to almost ALL doctors.

Patients who refuse to change their behaviors is something you will encounter in almost all fields of medicine, aside from, maybe, anesthesiology, pathology, and radiology.

On your OB/gyn rotation, you will see young women who don't "feel like" taking birth control....and end up pregnant over and over and over again. Or end up with chlamydia for the 4th time.

On your IM rotation, you may see endocrinologists battling with diabetics who refuse to measure their blood sugars and don't take their medications/insulin, or cardiologists who fight with patients about their high cholesterol. Pulmonologists have many patients who still smoke every day, despite having bad emphysema.

On surgery, you will see vascular surgeons who have had to operate numerous times on the same patient - because the patient didn't change their behaviors, their peripheral vascular disease got worse.

And if you think that peds is safe from this - one of the most frustrating encounters I remember was with a father who insisted that his chain-smoking had NOTHING to do with his child's severe asthma. 🙄

I may be viewed as a horrible person for saying it, but this is the kinda crap that any healthcare reform should be focusing on...if you wanna not take care of yourself...fine by me, but any care you get will be paid for OUT OF YOUR POCKET. Seems fair to me.

The sad reality is the government has no particular interest in improving public health...what are they to gain by outlawing cigarettes, McDonald's, etc?

It's frustrating, yet very motivating to me.

The first step should be to make anyone that doesn't at least TRY to take care of themselves to PAY.

 

[notinkansas]

That's why I think all the hoo- haa over increasing primary/preventative care as a part of health care reform (to decrease costs) is bunk.

Most people don't want to change their behavior. Plain and simple. Americans are too into instant gratification. And if satisfying our immediate urges leads to bad outcomes, no problem! We'll just sue those involved in the production of the items used to satisfy our urges (tobacco companies, McDonalds, etc) for "forcing" us to partake via evil marketing tactics. After all, the big, bad companies are eagerly creating products that kill for profit, right?

 

[notinkansas]

I may be viewed as a horrible person for saying it, but this is the kinda crap that any healthcare reform should be focusing on...if you wanna not take care of yourself...fine by me, but any care you get will be paid for OUT OF YOUR POCKET. Seems fair to me.

The sad reality is the government has no particular interest in improving public health...what are they to gain by outlawing cigarettes, McDonald's, etc?

It's frustrating, yet very motivating to me.

The first step should be to make anyone that doesn't at least TRY to take care of themselves to PAY.

Agreed. The government isn't interested in improving public health. They are interested in controlling the behavior of as many Americans as possible. And buying votes by providing free health care without requiring any personal responsibility.