Motivating your patients to do better with their health

[amestramgram]

Hi - what have been your favourite and long lasting ways to motivate your patients to do better with their health?

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[OrthoTraumaMD]

Threaten them with death or amputation. Works wonders for my trauma patients. Instant smoking cessation.


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[amestramgram]

How about for the huge crowds of obese people who are in for the chronic management of diabetes/ COPD/ degenerative joint disease, and motivating them to exercise?

 

[akwho]

Threaten them with death or amputation. Works wonders for my trauma patients. Instant smoking cessation.


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Reminds me of our rounds on hip fracture patients s/p ORIF.

"Get up and walk today or YOU ARE GOING TO DIE."

I've said this maybe 50 times, and reading out loud from home it sounds pretty intense. But they don't really walk if you don't say it to them, mostly due to pain and fear.

 

[Matthew9Thirtyfive]

Instant smoking cessation

I wish. I’ve taken care of multiple people who got more and more of their leg chopped off as they continue to smoke.

 

[TypeADissection]

I wish. I’ve taken care of multiple people who got more and more of their leg chopped off as they continue to smoke.

Sounds like we work in the same hospital. I'll see you at the bilateral AKAs tomorrow bruh. Cheers.

 

[235009]

Hi - what have been your favourite and long lasting ways to motivate your patients to do better with their health?

How about for the huge crowds of obese people who are in for the chronic management of diabetes/ COPD/ degenerative joint disease, and motivating them to exercise?

so innocent and naive. medical training will be a real kick in the acorns. sorry.

 

[mimelim]

Threaten them with death or amputation. Works wonders for my trauma patients. Instant smoking cessation.


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Lucky you. I need some tips, I probably bat 50/50 in getting smoking cessation with the death/amputation threats.

 

[amestramgram]

Yes I'm aware that there are legions of people who don't care about their health and expect you to be their parent, so no need to call me immature.
I'm asking the question for those who have been more successful in motivating their patients than myself. My philosophy is to not just sit around and grumble about it, rather, to seek advice from better doctors than myself.

 

[OrthoTraumaMD]

Lucky you. I need some tips, I probably bat 50/50 in getting smoking cessation with the death/amputation threats.

They get back to smoking—but as long as it’s after they have healed their fracture then I can live w that...


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[235009]

Yes I'm aware that there are legions of people who don't care about their health and expect you to be their parent, so no need to call me immature.
I'm asking the question for those who have been more successful in motivating their patients than myself. My philosophy is to not just sit around and grumble about it, rather, to seek advice from better doctors than myself.

🙄

I didn't call you "immature"

Also no one has figured this out and every patient is going to respond differently to different strategies

 

[VA Hopeful Dr]

Lucky you. I need some tips, I probably bat 50/50 in getting smoking cessation with the death/amputation threats.

That's probably 50% more than the surgeons we referred to in residency (not their fault by any means)

 

[takeurmeds02]

Honestly, you have to take time to figure out what their goals are in life and what resonates with them. For some it might be seeing their kids graduate, for others it might be another family member/friends that depends on them. And unfortunately, some people just don't give a damn.

The problem is that in many healthcare settings it's impractical and unrealistic that you'll garner enough rapport with a patient to figure out what message will give them that "Aha!" moment. We like to say that many of us are in this for those "3-5 minutes conversations that can change the patient's life" but those are few and far in between lol.

If you're really interested and you're not familiar, look up motivational interviewing.

Lastly, I'm always down for a little macabre humor on these forums and on the floors but don't lose that light - you could end up motivating that one person who in turn motivates hundreds of others.

 

[GoSpursGo]

Yes I'm aware that there are legions of people who don't care about their health and expect you to be their parent, so no need to call me immature.
I'm asking the question for those who have been more successful in motivating their patients than myself. My philosophy is to not just sit around and grumble about it, rather, to seek advice from better doctors than myself.

If there was some magical strategy that convinced patients to do what we tell them to do, everyone would do it. As it is, you do the best you can and take what you can get.

The one thing that may work is actually sitting down and having an extended conversation with your patients. If they see that it's important enough to you that you'll slow down and take time to express their concern, they may pay more attention to you. "Stop smoking or you're going to die" is thrown around so much that I think patients are numb to it.

That said, I have teenage patients with cancer who refuse to take their oral chemo, when not doing so WILL LITERALLY PROBABLY KILL THEM. And I'm a fellow in a pediatric subspecialty where I have enough time to sit down and have an extended discussion with my patients and their parents, unlike a bunch of PCPs who have no choice but to churn through as many patients in a day as possible. So, good luck.

 

[OneTwoThreeFour]

My understanding is that the only thing that has really been shown to correlate well with lifestyle modification is repeated conversations so that you eventually get someone moving into the contemplation phase of smoking cessation/diet/medication adherence.

 

[amestramgram]

Indeed that's the strategy I'm taking - giving motivational interviewing when time allows. I'm having a lot more success in peds than in internal medicine hehe. Hence why I'm doing adult and pediatric cardiology. Thanks lads and lassies.

 

[RNthenDoc]

Use plain English. Never use jargon.

Be clear about what you are communicating, and use teach-back to make sure they understand.

 

[Tenk]

The day you think you have a major breakthrough with a patient, when you know you changed their life and set them up on the path for the success is the same day you see them in the McDonald’s drive thru smoking a cigarette.

To answer your question you need only read one book: Motivational Interviewing by Miller and Rollnick.