Issuing orders to a patient then running out the door is not the most effective way to convince someone to change deeply personal, ingrained habits. But too many primary care doctors employ precisely that tactic, said Ann Lindsay, MD, a clinical professor in medicine at Stanford.
Part of the reason is that they’re pressed for time, with less than 20 minutes for each patient. But it can also be an attitude about their role, she said. “The way they’re taught, they think doctors are the experts and tell people what to do,” she said.
Yet, according to Lindsay, physicians who communicate well with patients are more than twice as effective in getting patients to make life changes. These doctors employ motivational interviewing: They ask patients what changes they feel they can make, then, in follow-up visits, ask what else they can do. They support the patient, enabling them to take incremental steps toward better health.
Lindsay describes the skill in an article that appears in American Family Physician. In the article, she describes a hypothetical patient, Joe, who’s reluctant to take blood pressure medications.
When Joe is ordered to exercise 150 minutes a week, eat more vegetables and whole grains, reduce his sodium, lose 10 pounds, and come back in three months, he merely rolls his eyes. But when a doctor asks him what he knows about hypertension, addresses his concerns and asks what lifestyle changes Joe could make, Joe becomes a participant in his health. He decides he can walk to work two days a week and order salad for lunch three days a week.
“Everybody basically wants to lead a healthy life,” Lindsay said, “but there are different beliefs and obstacles that contribute to ambivalence.”
Lindsay, who teaches motivational interviewing to physicians, nurses, health coaches and other clinicians, said they can all become better communicators. “It’s a learned skill,” she said. “And it’s not that complicated. You start with what patients know and work from there.”
She added that starting with small changes in a patient’s life is much more effective than insisting on an overhaul. Patients who are faced with a radical change in their lives often feel overwhelmed and don’t even try. But they feel they can make small steps, and many small steps add up to big changes.
She acknowledges that clinicians are pressed for time, but adds, “Think of all the time you’re wasting if you come up with a treatment plan and a patient doesn’t follow it.”
And a discussion about making lifestyle changes shouldn’t even take up a whole 20-minute visit, she said. “In five minutes you can come up with a plan that makes sense to people.”
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