More Than “Bedside Manner”: How Your Doctor Influences Your Health…or Not

medical-doctor-1236728Do you dread your yearly visit to the doctor? An acquaintance of mine recently shared how frustrated she gets with her physician. Her blood pressure is great, her labs are fine, she has energy galore and a healthy lifestyle, yet, the doctor insists on focusing on weight. The unbelievable part though is how little information this doctor actually gathered about my friend’s lifestyle. No, he did not ask about her concerns or her struggles. He had no idea she had been actively eating healthier, spending less time eating out and more time cooking healthy meals, was being more active and had decreased her stress level by changing jobs. No, he was making assumptions based on the number on the scale. Even though this friend had indeed lost some weight from some subtle changes in her lifestyle (not going on a diet, just making changes that resulted in normalizing her blood pressure, and the slight weight loss was coincidental). When my friend went to this visit she was actually very happy about her improvements in health parameters, but left feeling insulted and inadequate….like she was still doing something wrong.

It is a common scenario. Typical visits to the doctor often involve some type of health education and probably recommendations. Health professionals such as physicians, nurses, dietitians, and others have lots of knowledge in their heads, and they know what is best for us regarding what we need to do to be healthy. Typical advice:

  • You need to lose weight.
  • Cut down on sugar.
  • Cut down on fat.
  • Exercise more. At least 30 minutes a day.
  • Drink more water.
  • Drink less beer.

My question is: Do they REALLY think we don’t know what we are supposed to be doing? The problem is not in the “knowing”, the issue is with the “doing”, or the motivation to change. So the wise doctor or other health-promoter should probably consider focusing on how to assess motivation to change, how to identify the obstacles and how to help their patients to do what they need to do instead of simply telling them what to do and then scolding/judging them when they can’t do it.

Lo and behold, there actually is an approach to helping people change behavior called “Motivational Interviewing”, or MI.  This approach was originally used in the treatment of addictions, specifically alcoholism. But experts have learned that the empathetic and empowering approach of MI is also beneficial to many other fields where behavior change is key. Now, doctors, nurses, dietitians, therapists and others are getting trained because they want to help people achieve their behavior change goals, and they know from experience that the old-school approach (telling people what to do, shaming, scolding, etc) does not work.

Is your primary care physician trained in MI? Granted, some people are just naturally empathetic, and have the skills to motivate people to change. But, most of us use our instincts and do what comes naturally, and unfortunately, we are often wrong. What is wrong with emphasizing how forgetting your insulin is going to result in severe damage to your body? I know of one endocrinologist who threatened a young teen who had pre-diabetes that “if you don’t lose weight and get your blood sugar under control, we might have to chop off your foot!”. Do you really think that helped that kid leave with motivation to eat healthier? The opposite actually tends to occur. When we scold, shame and threaten, people actually become even more resistant. It doesn’t work. They don’t change. So if you leave your doctor’s office feeling shamed, guilty, bad or afraid, or even worse, you don’t want to ever return, well, chances are they may not be on top of their counseling skills.

Instead, when you leave your doctor’s office, you should feel heard. Your doctor ideally should be asking you some open-ended questions that require more than a yes-or-no answer. For example, instead of ” are you eating healthier?” a better question might be “tell me about the things you are doing to eat healthier, and what your obstacles are”. This type of open-ended question allows you to go through some details of what you have been doing or what your struggles are. Then, instead of the typical answer, or response of telling you what to do (“you need to eat more fruits and vegetables”), a more helpful response would be reflecting back what you said, and checking to be sure you were understood. For example, “so you have decreased eating out, but you still struggle with eating more fruits and vegetables because they are expensive and you don’t really like them, did I get that right?”. This type of reflective response shows empathy. There is some research demonstrating that patients who go to a doctor’s visit where they felt empathy actually leave and are more likely to be successful and compliant with recommendations verses those that were merely told what to do. We are all different, our issues are different, our lifestyles, and our readiness to change health behaviors, and being treated with empathy goes a long way to facilitate change.

So what does this mean to you? The most important thing in my opinion is to get regular health care.  When someone does not go back for follow up health care only because they were treated poorly, were shamed or blamed or otherwise disrespected, that is a tragedy. The repercussions can be great. Imagine developing hypertension and never being treated for it merely because you did not go back to your doctor.

If you can relate to being treated this way, I strongly recommend looking into finding a doctor who actually knows what motivational interviewing is. There is plenty of research involving the use of MI in a medical setting, and the benefits of treating patients with empathy. Talk to friends who love their physicians. Do some research into different practices, or just come out and ask directly. Don’t miss getting preventive care just because of the way you were treated. There are plenty of wonderful health care providers who have the skills to get you the help or support you need to be the healthiest you can be. Your health is too important to ignore. For more information on MI, check out the website: Motivational Interviewing

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