An Unconventional Approach to Patients Who Don’t Follow Your Advice
December 4, 2019
By Steve Vargo, OD, MBA
In our efforts to get patients to do what we want them to do, whether that’s buying a pair of glasses or using eye drops as prescribed, we often focus on our reasons for wanting them to take the desired action. This is typically a one-sided conversation where the doctor directs and the patient listens.
Unfortunately, most of us know all too well that patients are not always compliant with our recommendations. The early cataract patient who refuses to purchase sunglasses. The contact lens abuser who continues to over-wear his contacts. The convergent insufficient child whose parents decline vision therapy. Sound familiar?
Research in consumer psychology has discovered that people are often more likely to make a purchase or change a behavior when the decision is based on their motivations, not someone else’s. Getting patients to voice their own motivations and concerns can be a powerful tool for increasing the likelihood of doing what we are asking them to do.
For patients who have demonstrated resistance or ambivalence toward following your advice, consider the following approach. Ask the patient to rate their desire or commitment to making this change. If they respond with a low number, ask why they didn’t choose a lower number.
Doctor: On a scale from one to ten, how motivated are you to start wearing sunglasses outdoors?
Patient: I would say three.
Doctor: Ok. Why didn’t you say two?
Patient: Well, I know when I do wear sunglasses my eyes feel more relaxed outdoors. I also know that my risk of other eye problems you’ve told me about will reduce if I protect my eyes from the sun. My grandfather lost his vision from macular degeneration. I suppose I should take that more serious.
Notice that the patient is now expressing his own reasons for doing something. He has to think about why he’s not a 2. He then begins articulating his own intrinsically motivated reasons for wanting to do something. You learn not only how important the change is to a patient but also why it is important.
Another approach is to simply get the patient to discuss pros and cons. They will then verbalize their own reasons for and against change. All of this is grounded in a method called Motivational Interviewing. This is a patient-centered method that research and numerous studies have found to be effective for facilitating behavior change. As health care professionals we spend a lot of time attempting to change people’s health behaviors. Even getting someone to start protecting their eyes from the sun is a behavior change.
There is a natural tendency to push back when we feel someone else is trying to control our decisions. This is what makes selling difficult. Instead of feeling like the pushy salesman, you become the empathetic guide who is helping the patient get what they need based on their own stated desires (which likely align with our desires for the patient).
There is certainly a time to take a more direct approach with patients, but we know from a mountain of social science research that when people have their own reasons for doing something, they’re more likely to endorse the behavior and more likely to carry it out. This becomes a way to surface the patient’s own motivation for change by asking questions as opposed to dictating.
Human beings only have two responses to control. They comply or they defy. For those who defy, try to get them to elicit their own reasons for making a change. They might just talk themselves into it!
Dr. Vargo serves as Optometric Practice Management Consultant for IDOC. A published author and speaker with more than 15 years clinical experience, he is now a full-time consultant advising ODs in all areas of practice management and optometric office operations. For questions or comments about this article, please contact firstname.lastname@example.org.