One of the great challenges for physicians is to motivate their patients to make positive health behavior changes. Unfortunately, training on motivation, communication, and patient psychology is typically lacking throughout educational curriculums. Changing patient behaviors requires different strategies that must be tailored to each individual in order to be effective. Greater effort is needed on cultivating the communication and relationship skills that are necessary for motivating patients.
A motivational strategy that has been explored in clinical research has been the use of pictures to get individuals to quit smoking. Images of plaque in the coronary or carotid arteries have been used in an attempt to induce a transformative, emotional learning experience that will motivate patients to improve unhealthy habits. Although this practice is intuitively appealing and commonly done, there is little evidence that this approach results in clinically significant change in behavior. Findings from the few studies that have addressed this question indicate that the process and psychodynamics of behavioral change will be qualitatively different for various diseases and psychosocial situations.
Tailoring Approaches to Motivate Patients
At the patient–physician interface, we need to redirect and intensify our focus for enhancing motivational change on the human relationship dimension. It is clearly worthwhile to further study the motivational impact of atherosclerosis imaging on unhealthy behaviors, such as smoking, obesity, sedentary lifestyles, poor diet, and medication non-adherence in at-risk patients. The key is to find approaches that support efforts to take advantage of the teachable moment in patients who are ready to make changes in their health behaviors. That requires appropriate patient selection and tailored interventions.
“A paradigm shift in prioritizing and incentivizing better communication in the context of patient-centered care is needed.”
By improving patient–physician communication and relationships, there is enormous potential to motivate more patients to change. However, little is invested in enhancing communication skills education. Current models of medical education do not formally train physicians to be proficient communicators. Communication skills programs should be longitudinal across the medical education continuum. The goal should be to have graduating and practicing physicians become competent communicators so that they’re not forced to rely too heavily on technology and tests that are often misapplied. A paradigm shift in prioritizing and incentivizing better communication in the context of patient-centered care is needed.
More Work Needed on Communication
Empirical research is needed to prove the efficacy and relative value of communication- and relationship-based elements. Studies are lacking on the phenomenon of motivating patients, and more investigations are warranted to translate insights from the psychosocial sciences to clinical populations. Collaborative care programs are being established, but we’ve only scratched the surface of developing a better infrastructure to support the improvement of communication- and relationship-centered dimensions of care.
To motivate and sustain change in patients, a key component is to remember that professionalism and having a caring attitude is required from all healthcare providers. Our focus should shift toward clinical care processes and research that centers on human relationships rather than “one-size-fits-all” strategies to patient care. Only then will we be able to optimize our efforts for motivating patients toward optimal health behaviors.
Readings & Resources (click to view)
O’Malley PG. On motivating patients: a picture, even if worth a thousand words, is not enough. Arch Intern Med.2012 Jan 23 [Epub ahead of print]. Available at: http://archinte.ama-assn.org/cgi/content/full/archinternmed.2011.1948.
Levinson W, Pizzo PA. Patient-physician communication: it’s about time. JAMA. 2011;305:1802-1803.
Duffy FD, Gordon GH, Whelan G, et al. Participants in the American Academy on Physician and Patient’s Conference on Education and Evaluation of Competence in Communication and Interpersonal Skills. Assessing competence in communication and interpersonal skills: the Kalamazoo II report. Acad Med. 2004;79:495-507.
Harland J, White M, Drinkwater C, et al. The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care. BMJ. 1999;319:828-832.
O’Malley PG, Feuerstein IM, Taylor AJ. Impact of electron beam tomography, with or without case management, on motivation, behavioral change, and cardiovascular risk profile: a randomized controlled trial. JAMA. 2003;289:2215-2223.
Peabody FW. The care of the patient. JAMA. 1927;88:877.