Why you should cancel your doctor’s appointment

You heard me correctly.  Do not go to your next doctor’s appointment.  I repeat, do not go.  Do not pass go or collect money.

Now that I have your attention, you may be thinking what is this crazy doctor saying? If I had a dollar every time a patient came in and asked for my advice but didn’t follow it, I would have been retired long ago.

Why is this?

Change takes time.  It takes a patient who is not only willing but also ready to change.  And once ready, it takes 3 to 4 weeks or longer to fully implement any single change into our lives.

So why do you go in and talk to your doctor about your headaches but are not willing to wean off the caffeine or talk about your functional (non-disease related) abdominal pain but are unwilling to change your diet?  Do you like to waste your time?  Ours?  I know this is not most patients’ intent.  It all goes back to this: change takes time. I have been guilty of putting off necessary change myself.

Usually when the acute symptoms of headache or abdominal pain subside, so does one’s urgency to address them.  Our busy lives are often governed by things that are urgent leaving us little time to tend to things that are important but not urgent.

All of the above thoughts have been playing in my mind since two things occurred.  The first was when an elderly patient came in complaining of constipation.  I gave him my usual spiel. The same spiel I had given for years.  This particular patient wanted to schedule a follow up in case he wasn’t improving.  On follow up, his constipation had completely resolved.  I asked how long did that take. He replied, “two days.”  I asked how did he do it.  He said, “I did everything you said.”

Many times, we as physicians do not hear back from the patients who get better by following our advice.  This can make it seem as if all the counseling we do is ineffective.

The second instance was while collaborating with a good friend who is a health coach.  She counsels people holistically on how to be healthy which includes how to eat healthy.  All of her clients lose weight.  Yes, all of her clients lose weight.  We compared what we told our patients.  We said similar things.  So why am I as a physician ineffective in getting people to change and lose weight?

One key difference between our patients is that those who seek the services of a health coach are often willing and ready to change.  You would hope they are if they are willing to pay out of pocket to see one.  Whereas when a patient sees a physician it is often times related to an abnormal lab or blood pressure, which requires a lifestyle change that a patient is often times not ready to make.

Is the above my excuse? Can anyone make a person change? I used to think that it was all up to the patient and that there was nothing I could do. Now, I will strive a little harder to motivate my patients to get to the “ready” stage.  I want to do better.

Before your next doctor’s appointment ask yourself this: “Am I willing and ready to make a change?”

And I will ask myself how can I motivate patients to get to the next level.

Rajka Milanovic Galbraith is a family physician who blogs at Expat Doctor Mom

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  • http://pulse.yahoo.com/_3CY2U67646G7UIAHBQVTT2UP4Y Kristy S

    This article is very well-written, and an excellent reminder.  I came to the same conclusions about this kind of issue when I was going to school to become a Medical Assistant.  Thank you again for this article.

    • http://expatdoctormom.com/ Expat Doctor Mom

      Kristy

      Thanks for commenting on the post! I am pleased you liked it  Good luck in your endeavors as a Medical Assistant.  In my last office my right hand “person” was a MA and we were a great team!  I hope you experience this same wonderful relationship in your career!

      Best,
      Rajka

  • http://www.facebook.com/deborah.munhoz Deborah Munhoz

    Love your perspective and wisdom.  I would love the opportunity to support you and  offer insight into your question about how you can get patients ready to change.  What do people really want? . Do they want lower blood pressure or is it really the ability to spend more time at the park with their dog, family, loved ones?  That emotional core is your source of motivation for change.   Check out the article I published in Medical Economics with  2 physician colleagues  on how to use coaching skills to get at the essence of what they really want- so they will begin to make changes. http://ow.ly/7jrXa  I would love to know if you find this article helpful.

  • Doug Capra

    Doctor — Let’s assume, perhaps incorrectly, that you’re exaggerating for effect. So — I’ll also exaggerate for effect too. One of the key phrases in your little speech is this: ” I gave him my usual spiel.” Perhaps your too embedded in your “usual spiel.” Perhaps you need to climb out of your little, narrow box and go back to school and study current brain research and psychology to understand why human beings do what they do and how the brain really works. So, the health coach is successful just because his clients are ready for change and willing to change? Try this — the health coach is successful not just because of that, but also because he or she is an actual “coach” and understands how people’s brains work. He or she really understands how to motivate people.
         What I see in your little speech is so common in health care — it’s always the patient’s fault. Next time you shave, doctor, or brush your teeth — take a good look at yourself in the mirror. Read a little Socrates about the unexamined life. Try to figure you what you may be doing wrong. Try something different than your “usual spiel.” You’ll find that we’ve learned quite a bit about how the human brain works, what motivates people, why people don’t do what they should do, etc. Try being a doctor “coach” like your health coach friend. See how that works.

    • http://expatdoctormom.com/ Expat Doctor Mom

      Dear Doug

      My intent was not to incite you but to create discussion around what motivates change nothing further.  However, I am acutely aware that action (the way my words were written) does not equal intent. For this I apologize.  I enjoy learning from my colleagues(doctors nurses, therapists health coaches etc) in all fields.  The constant sharing makes me a better practitioner.  

      What I didn’t write in the article was how effectively I have helped patients to change. Perhaps making it sound  like I am never successful to help bring about change.  Much of this change has come about based on the relationship I have with my patients.  I am fortunate to be able to say that I have thoroughly enjoy my practice unlike many physicians in medicine. And I know my patients enjoy working with me in a mutually respectful relationship. 

      The term “spiel” was not meant to be used as you have used it.  All practitioners even you have routine things you say that are then tailored for the individual.   For example, patients want to know what  their options are:  to treat, to prevent, risks vs benefits etc. Many of these discussions are routine.

      I am not certain what prior interactions you have had with physicians nor will I assume as you assumed that I put fault on my patient, look in the mirror to shave(from my photo it is clear I am a female) and that I don’t coach.

      I wish you the same fulfillment with your clients as I have had with my patients.  May you be able to motivate change!

      Best Regards,
      Rajka

  • http://www.facebook.com/profile.php?id=655523194 Jeanine Satriano-Pisciotta

    Loved the article! And probably why I rarely see my MD. His office calls for my yearly but I make it in about every 2-3 years. I’m a healthy 45 year old nurse who “knows everything”. Everytime I go he wants lab work, mammo, gyn exam, etc. I tell him I’m fine- BP 96/50, hate moderate exercise 4 times a week, and that if I’m sick, I’ll come and see him. He explains all the reasons why I should come and prevent problems, so I relent and consent to his exams. Then on my follow up he tells me I’m healthy as a horse, then tells me about age related changes I can expect. I tell him I told you so, but this is the routine. It probably drives him crazy, but his office still calls, so I guess he’s keeping me. :)

    • http://expatdoctormom.com/ Expat Doctor Mom

      Thanks Jeanine!  It sounds like your relationship with your physician works for you and that you are fond of one another. I suspect you don’t drive him crazy!

  • http://expatdoctormom.com/ Expat Doctor Mom

    Thanks Deborah!  Great resource!  Will share with other health care providers I know.  I would have to say, I was already doing a good portion of what you recommend in the article.  It is nice to have a more actionable plan that fully empowers the patient. 

    I always try to learn what works from my patients, friends, family and other health care providers and continually fine tune what I do.  It is all about the patient.  And unlike what @google-49321bec5ac78110aae150b5563aab3d:disqus above may think, No, I don’t put blame on my patients.

    Best regards,
    Deborah

  • http://www.facebook.com/people/Jackie-Swenson/100000046998781 Jackie Swenson

    My 88-year-old Mother is the one who has taught me not to follow doctor’s instructions.  She used to share her prescriiption medicine with her children, thinking it would work since we had contracted the same cold.  She would cut short the course of taking antibiotics because she believed “all effective medicines are poisonous!”  But she did take us to the doctors when we were obviously ill. 
     
    She used to be active in local politics in our community and was never intimidated by our local doctors.  My Mother has saved my life (no, not by giving me her antibiotics :) because I’ve learned to be an ‘independent thinker’.  You see, my doctors never believed there’s anything wrong with me ‘physically’ before the MRI (demanded by myself after several referrals/tests had failed to find the culprit of my huge headaches) showed the huge, life-long brain tumor in the center of my brain. 

    Mother has been right all along…

    • http://expatdoctormom.com/ Expat Doctor Mom

      Hi Jackie!  Thanks for your response. I am very sorry to hear about your brain tumor and hope you are receiving excellent care. 

      I am a strong advocate of trusting your instincts that is why I will ask a patient what do you think is wrong if my explanation doesn’t seem to sit well. I watch body language etc to ensure I know whether a patient is comfortable with a diagnosis.  I just wrote and article on my own site about this: Trusting your instinct when it comes to your health care and do advise patients to discuss with their doctors what they feel is wrong.  Here is the link:  http://expatdoctormom.com/2011/10/when-it-comes-to-your-health-care-trust-your-instinct/

  • http://pulse.yahoo.com/_UDJTUH45CFUC6LKCBLB6FGRDKU Diane

    I find this very interesting and true! despite what the naysayers say too. The basic care of the human body is pretty simple – good (healthy) food, exercise, sleep, fun, work, play and love. Personally, I’d throw some pets in there too and plenty of fresh air and some naps. Hey, guess what, a good dog (or 2) can help with the exercise, fresh air, love, play and fun (and some work and need to work.)  Healthy food is getting easier even if you choose fast food! Now you just need sleep and work. Avoiding vices from the getgo is easier than stopping them, but if you can show the cost savings and continue the encouragement, maybe…… I will preface this with the fact that it is much easier to be the person who practices all this and can offer the advice than to be on the other side of the coin……. Right? I don’t have much direct patient care in my current job but in the past we spent most of the day counseling folks with diabetes, HTN, and hi chol and on smoking at a clinic in a teaching hospital. You truly do have to be creative in your approach to win over folks to the “healthy” side! But we were a follow up clinic and had time to spend on specific things like this too. Not saying the folks were motivated, but you could find that “motivator” at times, for example, the thought of starting insulin could encourage folks to walk around their house with cans of beans and then eat those beans instead of fast food.

    • http://expatdoctormom.com/ Expat Doctor Mom

      Thanks Diane for your comments!  Agreed it is easier to be the person who already practices “all this”.  Also you hit a key point: having TIME to counsel!  Love your visual of walking around the house with a can of beans and then eating them!

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