Motivation is a process


Category : Medical Rants

Earlier this week I talked about my weight loss project.  In that post I talked about Nick Saban and “the process”.  Living here in Alabama, where Alabama Football is a 60 weeks a year topic, one quickly learns that Coach Saban rarely talks about winning, or keys to winning.  Rather he talks about following a process.  According to Saban (clearly well liked here, although not elsewhere), if his team does the things that they can control, blocking, tackling, picking the correct receiver, minimizing mistakes, etc. , then he is satisfied.  He often complains after victories when players do not perform at their capabilities.

So in Alabama the process has become a mantra.  As I wrote about my weight loss project, I realized that I was focused more on the daily process than any ultimate goal.  I reasoned that following a correct process will eventually lead to success in the desired outcome, but that focusing too much on the outcome without attending to the process was a losing proposition.

As I deconstructed my decision to start this project, I understand that no one thing stimulated me.  I wanted to lose some weight for quite some time, but I did not have enough internal motivation to succeed.  Internal motivation comes through a building process.

Over time I tried to understand what I could change.  Then I searched for techniques to help me continue my motivation spike.  These processes work, because they fit my personality.

Can we generalize to patients?  Clearly motivating patients leads to great frustration for many physicians.  If patients would just listen to us, they would have such better outcomes.  But dammit, they do not generally listen.  We do not get the outcomes we want – patients stopping smoking, stopping alcohol or illegal drugs, losing weight, exercising – and we just do not understand.  Many physicians have the energy to continue sapped by the lack of outcomes.

But motivation is a process.  Each opportunity to work with our patients gives us a chance to espouse better lifestyle choices, better medication adherence, better processes.  Our words are not magic.  Sometimes they work; sometimes they just add another piece of straw.  We must learn to focus on the process.  We must try different motivational tactics.  But we owe it to our patients to try, even if we believe that our actions are futile.  If we continue the process, showing persistence and understanding that the goal is to say the right things in the right way, eventually outcomes will follow.  But with motivation we must focus on the process and not allowing outcome failures to dissuade us.

Comments (8)

Dr. C:
Nick Saban’s process works a helluva lot better with that offensive line, that defense, and those running backs.

You’ve just added another straw.

Process doesn’t work in the Get With the Guidelines of the AHA/ASA because hospitals crow about meeting guidelines but never mention results. This leads to the failure of only 10% full recovery in stroke rehab.

Back in the day I was taught the concept of positive reinforcement, a concept that seems to have fallen out of favor. Today in almost every endeavor confrontation seems to rule and anything less than total victory is considered failure.

You must not be sticking to your diet or you would have lost more weight. Bad patient.

You may have cut down on your smoking, but not stopped. Bad patient.

You are not taking your medication or we would have seen a bigger change in these results. Bad patient.

Trying to achieve and maintain the best health possible is a process. Diets may fail due to financial reasons, access to food items, or family pressure. Watching people try to quit smoking has made me aware that a cigarette is the devil in a paper wrapper.

I am going to go out on a limb and make a medical statement: sometimes the pills do not work, do not just add more pills or up the dosage. One doctor who volunteers at a charity clinic wrote that for some patients their daily medications form a “food group.”

Health is a process. The local diabetic specialist wants his patients to loose one or two pounds a week so as not to upset their metabolism. A drug reps job is to sell and they have no idea if the stuff works, nor do they care. A pill to stop smoking based on biased date that is then used in ghostwritten pharma sponsored articles is not what you want to rely on in treating your patients.

Patients will respond to a relaxed doctor who is willing to work on the process of achieving better health. Demands and barking orders, artificial goals that are impossible to meet and the constant drone of “bad patient” will only result in frustration for both the doctor and patient.

Ultimately this is not about you, yes I know there are all kinds of practice metrics, but moving that patient population in the right direction is the process, and the goal.

Steve Lucas

Although I appreciate your post and like it, I have seen processes been thought of as an outcome in itself ( like your bureaucracy quote). In my field, for a lot of doctors, nurses and patients, diagnostic tests (bronchoscopy) is an outcome not a process. Differentiating the two is very important.

I am talking only about our quest to motivate patients. Because creating change is so difficult we should not get frustrated with failure, as long as we keep working at the process of motivation. I am not talking about performance measures at all in this post.

While you have to take responsibility for your own behavior for successful weight loss, it helps to have support — of the right kind. Pick people to support you who will encourage you in positive ways, without shame, embarrassment or sabotage. Ideally, find people who will listen to your concerns and feelings, spend time exercising with you or creating healthy menus, and who will share the priority you’ve placed on developing a healthier lifestyle. Your support group can also offer accountability, which can be a strong motivation to stick to your weight-loss goals. If you prefer to keep your weight-loss plans private, be accountable to yourself by having regular weigh-ins and recording your diet and exercise progress in a journal.

[…] Each opportunity to work with our patients gives us a chance to espouse better lifestyle choices, better medication adherence, better processes. Our words are not magic. Sometimes they work; sometimes they just add another piece of straw. We must learn to focus on the process. We must try different motivational tactics. But we owe it to our patients to try, even if we believe that our actions are futile. He makes a great point, and you should check it out the whole thing, as I haven’t done it justice. […]

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