Behavioral Health Minute

November 2007 - Catch patients in the act of being competent

The short summary

Recognizing and asking about patients’ efforts and positive changes, even if not completely on target, helps to build relationships and “gets out on the table” some details about how people approach their lives.

The modestly longer reflection

Whenever patients report some accomplishment… stopping drinking, logging blood pressures, making dietary changes, handling a motor vehicle accident with some degree of grace… I like to acknowledge that and if possible talk about how and why they did it.

All of us instinctively try to be enthusiastic about patients’ efforts.  In addition to this, I think that the “how” and “why” questions can often reinforce people’s competence.

“No alcohol for 5 years… wow.  How did you do that?”

“It’s striking to me that you have had this profound accident and here you are in a wheelchair, but you’re still pretty cheerful… what is this like for you and how do you do it?”

“You say you have been working on your diet… what changes have you been making, in particular?”

“You’re telling me you’re pretty burned out, but you’re still going to work and taking care of your kids… what keeps you holding it together as much as you are?”

“So there are some days when you deal with the financial stuff you have been describing to me a little better… what are you doing on those days that you think makes some difference for you?”

I think there are three reasons for having these conversations with people, even briefly.

1. It is affirming for patients to have their doctors recognize their efforts.
2. It gives us a window on how people individually cope with life.
3. It is more fun than talking about people’s failures.

Even if people’s accomplishments are off-base, we can still give them credit for trying.  Example… the woman whose dietary efforts consisted of eating Healthy Choice TV dinners. This may not be the final end point, but she gets credit for trying.  Similarly, we can acknowledge the responsibility people take for their health if they come in with modestly outlandish approaches they have found on the Internet.

Follow-up

Notice some times when some example of a patient’s competence could go unspoken… and speak it.  Ask them how they did it.

Fred Craigie, PhD