Motivating Patients – a Physician Coach Brings Neuroscience to the Rescue!

As healthcare providers, we need to communicate with and motivate many different types of people each day. With some, we feel as if our communication is seamless. We say what Screen Shot 2015-05-02 at 10.22.16 AMwe mean, and they understand and respond appropriately. With others, our words are misinterpreted. Where we meant to reassure, we instead provoke anxiety. As we try to motivate, we instead discourage. As a physician coach, I work with physicians to help them communicate more skillfully.  One of our current challenges is that we’re asked to do more in each patient visit, while being given less time to do it.  That means that we need better tools than simply sitting across from a patient and leisurely explaining what they need to do.  The exploding field of neuroscience can provide us with better ways to engage with people who might have different ways of seeing the world than we do so we can be more effective and efficient in caring for them.

Christine Comaford, serial entrepreneur/venture capitalist/former Microsoft engineer/executive coach, explains that there are 4 meta-programs that we each use to process the information coming to us. Two of them are particularly useful in dealing with patients. The first, “toward-away,” proposes that some people move toward rewards and others away from pain. We can ask, “What do you want in your work/your home/your life?” If the person describes what they want to achieve or attain, they are likely “toward” processors. They will resonate more with words and concepts that focus on what they will get from an intervention. If they speak more about wanting to prevent a disaster or “hold the fort down,” we might want to emphasize what they will avoid. Knowing what motivates each patient allows us to select appropriate language and examples. A toward person may be energized to stop smoking if he thinks he will have the energy to play with his grandchildren. Describing the debilitation and suffering that results from smoking may pack more of a punch for the away person.

The second dichotomy is “active-reflective.” Active people like to take immediate action and move ahead. Reflective people prefer instead to analyze the situation, obtain data and opinions, and then decide. If we ask, “How do you solve problems at work?” we’ll hear the active people say, “I like to make a decision and move on.” The reflective people will share that they like to weigh all their options before moving ahead. While we need to fully explain the procedure and complications of any treatment, the active person will be satisfied with less detailed information and may feel more comfortable with a plan to “get it done” and “not wait.” The reflective person may need more information to make a decision to undergo treatment and will be reassured by words such as “could” or “consider.”

During our medical training, we learn a new language – the language of medicine. We begin to use words derived from Greek and Latin that end in –itis or –ectomy. As we learn to skillfully communicate with patients, we learn to translate these words back into English so our patients understand. Neuroscience now provides us yet another language – a simple language that holds enormous power for influencing and motivating our patients to make choices that support their better health. While it does take some time and attention to incorporate into our daily practice, I guarantee that it’s easier and less complicated than memorizing all of those mnemonics during medical school!

About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
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