Lecture 21: Motivating Patients Flashcards
Dr. Fredrick Ross
- In 2002, a Manitoba physician, Dr. Frederick Ross sent all of his patients an ultimatum telling them that they had to either quit smoking in 3 months or get another doctor
- He had a 50-year-old female patient who had to get a tracheotomy from smoking. After her tracheotomy, she went back to smoking
- “I got fed up with wasting my time treating people with smoking-related diseases. People who continue to smoke are not interested in maintaining their health.”
Koestner on Dr. Ross’ approach
Koestner disagrees with this; most smokers want to quit smoking but it’s really hard to do so
media response to Dr. Ross
The media response was overly positive
patient response to Dr. Ross
- 30 people told Dr. Ross that they wanted to come see him for help with their smoking
- “I am surprised at how positive the reaction has been. The support was overwhelming, even from patients who smoke. Since I issued the ultimatum I have had only 3 patients request that their files be transferred to another doctor.”
- “The patients’ response shows that most of them want to quit but needed to be pressured to do it.”
- “I have had a lot of demand for the patch and other methods of quitting. A lot of people are telling me how they are trying to quit. They seem to want my approval.”
- “I think it’s good. It’s scaring me and I think he’s a good doctor and I like him so I don’t have any choice but to quit smoking.” – Dr. Ross’ patient
prevalence of smoking in Dr. Ross’ patients
- Dr. Ross had 5,000 patients, 10% of whom were smokers
- Nationally, 25% of adults smoked at the time
problem with Dr. Ross’ approach
it relies on extrinsic motivation and control, which are good ways to motivate people
Dr. Geoff Williams
- Idealistic young internist
- Competent and committed
- He learned about motivation from Deci & Ryan
- Dr. Williams understands that patient motivation is part of a doctor’s job
- “How I interact with the patient will have a major impact on their motivation.”
power imbalance in the medical context
- We feel nervous when we see doctors, especially when there’s something wrong
- Doctors normally don’t worry about whether patients have gotten the message or understand what they have to do
- Doctors are busy and want to get on to the next patient
- Studies show that doctors let patients talk for an average of 6 seconds before interrupting them
autonomous motivation
feeling a sense of volition and choice in one’s behaviour
autonomy support
taking and acknowledging another person’s perspectives, providing choices and meaningful rationale
the specifics of autonomy support
- Make eye contact
- Ask open-ended questions
- Listen carefully
- Do not interrupt
- Encourage initiation and involvement
- Provide a rationale for your suggestions
three studies by Williams
- Smoking cessation
- Medication adherence
- Diabetes control
findings of Williams’ studies
doctor autonomy support -> patient autonomy motivation -> adherence to medical regimen
Williams’ study 1: smoking cessation
- 230 patients meeting with a personal doctor who had been trained in National Cancer Associations Brief Motivational Interview regarding smoking
- 39 years of age
- 26 years of smoking
- Motivation was assessed 2 weeks later
- Check-ups at 6, 12, and 18 months
- Self-reports were validated with chemical tests
- Doctors’ interviews were tape-recorded and coded for autonomy support
- Measured patient motivation 2 weeks after meeting the doctor: controlled vs. autonomous reasons for quitting
smoking and lifespan
Smoking shortens your lifespan by about 14 years and makes you more prone to illness
