What motivates patients?


Category : Medical Rants

Most physicians learn during training that patients most likely change behaviors when faced with their own mortality. The coronary care unit gives patients the impetus to stop smoking. The intensive care unit improves medication compliance.

This study makes sense. It shows that when patients understand the severity of their disease, they change their behaviors! Motivation: For Patients, There’s Beauty in the Ugly Truth

Researchers studied 505 asymptomatic patients on statin therapy who had their arteries examined by electron beam tomography, which produces a picture of arterial plaque. Each patient looked at the actual scan, which clearly showed the artery-blocking plaque as bright white spots.

The patients were informed of the severity of blockage, and the researchers explained the consequences related to heart disease.

After controlling for age, sex, hypertension, diabetes, tobacco use and family history, the amount of plaque seen on the scan at the outset of the study remained an independent predictor that a patient would stay on a prescribed lipid-lowering medicine.

The more severe the plaque accumulation, the more likely the patients were to stay on their medicine. Among the 25 percent of the participants with the least severe buildup, 53 percent were still on their regimens when researchers followed up an average of three and a half years later. By contrast, among the 25 percent with the most severe accumulation, 92 percent were still taking their drugs.

One of the poorly understood values of continuity care is the motivation principle. As I develop a relationship with a patient, I more likely can influence them to improve their health behaviors.

We must use different strategies for each patient. Knowing the patient helps; experience in doctor patient communication helps; and obviously being able to explicitly communicate the implications of the problem helps.

I cannot endorse these scans just for this purpose, however, if we find these findings reproducible, one could make the argument that such data may help improve outcomes through this seemingly indirect mechanism. Sometimes tests have value even when they do not lead to dramatic therapy.

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Comments (6)

I guess one reason patients are not as committed in following medical advice, even for common conditions like the dangers of smoking and high cholesterol, is the little amount of time doctors devote in explaining the consequences of these problems. This study would indicate you have to instill a certain amount of fear to get patients’ attention. If this goads patients to do things better, I would not be against this practice to keep them in line, no matter that some people may view this as a form of intimidation.

Another reason I think patients do not comply with what their doctors tell them is the confusion from vast amounts of conflicting information they read from books, newspapers and, more recently, Internet Websites. A lot of this information comes from alternative practitioners who also use the intimidation factor by warning of side effects that patients experience with drugs, while highlighting
the alleged safety of their products like herbs and other remedies made of God-knows what. One favorite website of mine, for example, always calls attention to the “myths of cholesterol”, which in effect tries to discourage the use of statins.

For doctors too busy to impart the right amount of time to educate their patients,
an assistant like a trained nurse or nutritionist to bolster usual medical advice would be a valuable help, and I have seen it work quite well. Patients also appreciate this extra effort.

In the main, however, compliance with medical advice is the patient’s ultimate responsibility, no matter what methods we use in imparting that advice.

A comment and a question. First, I think, unfortunately, a management by crisis mentality seems to pervade human behavior from individuals to bureaucracies (especially the government). My question is: how much does electron beam tomography cost?

Two quotes, approximate due to being from memory:

In the Bhagavad Gita, Krishna says, “Though he sees others dying all around him, no man believes that he himself will die.”

From Christopher Marlowe: “Nothing so sharpens the mind as the footfalls of the hangman.”

Of course it’s nice to have peer-reviewed empirical evidence to back it up.

There’s only so much the practitioner can do, but it seems clear that doing any less is unethical and harmful. So the question is, how best to communicate the severity of a patient’s condition without intimidation? One avenue that is just being explored in healthcare is the use of Web 2.0 technologies like blogs and wikis in which practitioners can interacts with patients, patients with each other, and all can reference the wealth of other material (good or bad) available on the Web.

If your patient is going to be influenced by useless information provided by dilrods, better that it happen in a forum where the practitioner and other informed individuals can lead the patient to a more accurate view of the world.

And just occasionally, the dilrods may have stumbled onto an idea or technique the practitioner might find useful. In many cases, herbal medicines do work, and with refinement can lead to medications that work even better; e.g., the studies on anti-angiogenetic properties of certain Chinese herbal remedies referenced in Integrative Cancer Therapies earlier this year (http://ict.sagepub.com/cgi/content/refs/5/1/9).

“I cannot endorse these scans just for this purpose, however, if we find these findings reproducible, one could make the argument that such data may help improve outcomes through this seemingly indirect mechanism.”

What about for patient education purposes?

[…] these lines, a recent study showed that patients with high cholesterol are more likely to be motivated to stay on their […]

[…] these lines, a recent study showed that patients with high cholesterol are more likely to be motivated to stay on their […]

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