How do you get patients to listen to you/follow your orders?

[Hemichordate]

I was just wondering... as a doctor, how do you plan on getting patients to do what you want them to do so they can improve their health? If a patient feels strongly about an issue (i.e. losing weight isn't that important), how do you persuade them to follow you instead? Since you'll probably have to treat lots of patients each day, you can't possibly check up on them all, so how can you make the biggest impact on each of them in a limited period of time?

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[a winner is you]

You can lead a horse to water but...

 

[FrkyBgStok]

dr. cox said it best in the first season of scrubs: turns out you can't save people from themselves.

 

[QofQuimica]

I was just wondering... as a doctor, how do you plan on getting patients to do what you want them to do so they can improve their health? If a patient feels strongly about an issue (i.e. losing weight isn't that important), how do you persuade them to follow you instead? Since you'll probably have to treat lots of patients each day, you can't possibly check up on them all, so how can you make the biggest impact on each of them in a limited period of time?

How would you persuade your friends to do something you think would be good for them, like ditching a loser boyfriend/girlfriend or laying off the beer a little?

Patients are not subjects of a monarchy who you get to order around. You're more like an advisor, not the boss of them. As with all interpersonal relationships, people have to trust you, and even more importantly, they have to be internally motivated to do what you're advising. Sometimes nothing you do or say will persuade someone to do something. In that case, you can provide the advice, but that's about it. Sometimes educating patients will convince them to make a change, or at least to think about making a change. These are the patients who you can help the most. Occasionally there will be a patient who unquestioningly "follows orders," but this is definitely not the norm in 21st century America.

These interactions with patients are the kind of thing that people are talking about when they say that medicine is an art. You won't be very successful in clinical medicine if you approach your job with the mindset of telling patients what to do rather than giving them advice and education.

 

[ACSurgeon]

I was just wondering... as a doctor, how do you plan on getting patients to do what you want them to do so they can improve their health? If a patient feels strongly about an issue (i.e. losing weight isn't that important), how do you persuade them to follow you instead? Since you'll probably have to treat lots of patients each day, you can't possibly check up on them all, so how can you make the biggest impact on each of them in a limited period of time?

The sad reality is that 90% of patients won't follow lifestyle recommendations that you make, and the 10% that actually tries will do a lousy job at it. That's why you'll find diabetics and hypertensives on multiple-drug regimens w/ poorly controlled disease more often than not. Over the past few years, "Motivational Interviewing" has been introduced as a way to influence patients who are wanting to change but lack the will or know-how. For docs who do it well, they can supposedly change a patient from one who is gonna do a lousy job complying, to one who will do okay. That still leaves the 90% of patients who don't care for what you say untouched, but it something, right?

Now, my numbers might be exaggerated a little, and this will certainly vary from one patient population to another (some patients are their own health advocates, others are completely ignorant about their health).

This is the reason many medical students get turned off by primary care, as patient compliance is a huge factor in seeing results (vs. specialties like EM where someone comes in ). It's also why some students want to do primary care (If you are THAT good, you can make a huge impact at a relatively low cost).

Hope this helps.

P.S. if you want to experiment with this, try convincing a family member over the age of 50 to get a colonoscopy (recommended for everyone over 50). You'll quickly get the feel for the 90% of patients who blatantly ignore medical recommendations.

 

[km11]

http://www.aafp.org/afp/20000301/1409.html

Read this

 

[Mace1370]

The force.

 

[seelee]

Verbal abuse and humiliation.

 

[medstudent87]

Verbal abuse and humiliation.

I shadowed a doctor once whose signature "technique" of getting patients to comply was asking them, "DO YOU WANT TO DIE?"


Honestly, I think it may have been more effective than just saying it'd be good for you to control ur blood sugar, or whatnot lol

 

[seelee]

I shadowed a doctor once whose signature "technique" of getting patients to comply was asking them, "DO YOU WANT TO DIE?"


Honestly, I think it may have been more effective than just saying it'd be good for you to control ur blood sugar, or whatnot lol

That's funny because in one of my med school interviews, I was asked the question:

"What would you say to a diabetic patient who refused to alter his lifestyle or take his meds".

I responded that I would point out that if he did not make these changes, his health would likely deteriorate and he would die (in a pretty miserable manner). I would tell my patient that I would help him anyway I could but the responsibility was ultimately on his shoulders.

The interviewer looked at me sideways and didn't say anything. I wasn't accepted there.

Maybe I should have offered to hold his hand or something.

 

[GoBuckeyes913]

I was just wondering... as a doctor, how do you plan on getting patients to do what you want them to do so they can improve their health? If a patient feels strongly about an issue (i.e. losing weight isn't that important), how do you persuade them to follow you instead? Since you'll probably have to treat lots of patients each day, you can't possibly check up on them all, so how can you make the biggest impact on each of them in a limited period of time?

You can tell people until you're blue in the face, but the reality of it is that they are going to do what they want to do, even if they know it's bad for them. There is no magic persuasion technique.

Unless you are saving their life at that moment in time, don't expect to hugely impact lives and save the world, you'll be disappointed in medicine if you do.

 

[ArthurIhde]

hmm i can get it

 

[ACSurgeon]

I shadowed a doctor once whose signature "technique" of getting patients to comply was asking them, "DO YOU WANT TO DIE?"


Honestly, I think it may have been more effective than just saying it'd be good for you to control ur blood sugar, or whatnot lol

We had a patient in his 40's undergo a BKA secondary to Buerger's disease (secondary to smoking), and post up, he talked about "seriously trying to quit after recovering." In other words, losing a limb wasn't good enough to get him to quit. So, not sure the scare tactics work. You have to get the patient to internally recognize that they should AND could change their behavior.

 

[seelee]

We had a patient in his 40's undergo a BKA secondary to Buerger's disease (secondary to smoking), and post up, he talked about "seriously trying to quit after recovering." In other words, losing a limb wasn't good enough to get him to quit. So, not sure the scare tactics work. You have to get the patient to internally recognize that they should AND could change their behavior.

This implies that there is a something that you can do, or something you can say that causes this internal recognition. I don't think a doctor (or anyone else) can get the patient to make this leap. A doctor can provide information, and the patient can even accept it and know it is right, but a recognition that change is possible and necessary is entirely internal.

 

[mmmcdowe]

I'll give them candy.

 

[unsung]

Verbal abuse and humiliation.

See one, do one, teach one...