When Medical advice doesn't lead to change in Patient Behavior

Dr. Adam Tabriz

It’s impossible to get people to change their Act unless there’s a Personal connection by which they can empathize

Photo by CDC on Unsplash

The human being is a creature of behavior. We all, as individuals, act in a certain way. Not everything we do comes across as attractive to the bystander. Yet, besides being behavioral creatures, we are also working hard to entice each other to change behavior. But influencing others to modify deeds is rugged and comfortable at the same time. It is accessible because there is an idolized connection between the two parties. One such example is the celebrity influence on the fans.

Patient compliance is one clear example of how personal relationships between doctors and patients play a meaningful role. In other words, obedience reflects an intimate connection between the two central players of clinical encounters driven by set behavior.

Behavior is about how we, as individuals and also collectively, act with ourselves, others, and the environment around us. Whether internal or external, conscious or subconscious, overt or covert, and voluntary or involuntary, almost always, there is a factor of pre-programmed response to various stimuli or inputs. Behavior pertains to a variety of actions, operations, interactions, and features. The quality of behavior is merely relative. What determines Good and bad behavior is nothing but the product of the reflection a person perceives from their surroundings and significant others. For instance, a religious person values the right action based on the holy book (God) or their spiritual leader’s norms. Whereas a patient or doctor sees good behavior based on the patient’s trust in the treating physician. Irrespectively, an action is always associated with a particular level of the interrelationship. It pertains to the connection between two people and some other phenomenon or agent, such as an idea, doctrine, and social norms. Then again, the goodness and evilness of the behavior are only determined relative to such scenarios’ precise standards. For example, good behavior is commonly recognized to be loyal, show empathy, and respect others. In contrast, it is terrible to Gossip and gets help for bad behavior.

Change of Behavior is the Upshot of Individual Circumstances

People wouldn’t contemplate a change of behavior unless there is a factor of necessity. Everyone can change, but that doesn’t necessarily mean they will. However, anyone can make an effort to modify specific habits or routines. Even some perspectives of attitude and personality can transform over time. They may be even so with some dedicated effort. All in all, a change of behavior is the product of circumstances.

The circumstances often require some form of instigators, such as personal connection, sympathy, or idealization. Within every event of interpersonal relationships, there rests the factor of personality. The latter is a phrase used to describe attributes that are uniform across time and place. For instance, we expect a highly extroverted person to be pleasant at home, work, or school. While personality is not a classic predictor of behavior, it still provides a general impression of how a person is expected to think and behave. A highly opinionated patient with a robust consumeristic attitude will be less likely to follow a pure utilitarian population health approach dictated by a treating physician vs. what is genuinely perceived as the proper treatment by the patient. Hence, although the patient's request may be impractical at times, what matters within the doctor-patient relationship is incorporating a special bond between them. Once a personal connection is also established, the same result can be delivered or not delivered as if one upheld the pure utilitarian approach. In a simple word, change of behavior is not about dictating or convincing patients but is more about the personalization of the doctor-patient relationship.

In reality, change is a process, not an event. That is what ideally happens during the patient clinic encounter. Successful behavior change occurs only in steps, and the length of such change is determined on an individual basis. The long-lasting change most likely happens when it’s self-motivated and rooted in positive introspection.

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Requirements for someone to change behavior

Patients won’t change their lifestyle or behavior by merely bombarding them with evidence and practical reasoning. Patients need the opportunity to examine their anecdotes. When doctors try to persuade patients, who need motive but no information, it will be counterproductive to throw more evidence. Instead, creating a safe atmosphere where patients can explore motivations they already possess. To justify some form of status quo, patients need to re-assess their narrative, particularly any self-defeating or creative stories they are narrating themselves. Getting someone to commit to change is not the same as getting them to change. The principal predicament in every behavior change is that people overestimate the influence of their willpower. They fail to see the risks ahead of them. So, they place their heart and soul into an unobtainable effort. They tripped up by obstacles they never anticipated and often relied on quick fixes.

The solution; as physicians and patients, we must enlighten our eyes. We need to spot the hidden influences around us and the forces that are keeping us stuck. Once we remember them, we can tackle them.

Human beings tend to group various influences of behavior into six sources: three motivators (Personal, Social and structural motivators) and three enablers (Personal, Social, Structural Enablers). Most stubborn glitches persist because of unseen or unnoticed influences that are keeping us stuck. Once we see them, we can transform them. However, if we don’t change them, we’ll remain stuck.

When it comes to Promoting Behavioral Change, shall we Advise or Order?

Expecting a patient to change his healthy lifestyle is every physician’s motive. Yet some hope patients accept those changes of behaviors unconditionally; others take the advisory role. Undoubtedly, ordering a behavior change is convenient but not necessarily convincing; hence it is short-lived, so patients’ compliance is transient. On the other hand, offering advice without personal connection and trust will also fail to sustain.

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Patient Behavior Change is about Compliance with Physician Advice. No particular intervention technique can enhance the abidance of all patients. Accomplishment depends upon adapting interventions to the unique characteristics of patients, disease conditions, treatment regimens, and how that patient appreciates the physician.

Patient Compliance with Physician Advice is Beyond Trusting Relationship

Compliance is the degree to which the patient’s behavior matches the physician’s recommendations. It implies patient involvement inadequacy and is typically associated with negative characteristics such as yielding and accession.

Non-compliance often cannot be explained because the patients possessed an understanding of their problem, which was incompatible with their physicians’, nor were they unable to understand the diagnosis they received. However, their diagnosis and treatments play a specific role in their daily lives, which explains their failure to follow physicians’ recommendations. Patients’ use of therapy frequently reflects their desire to control symptoms within the constraints of their daily routines. That points to the overwhelmingly personal solid nature of a doctor-patient relationship and, within such a framework, the significance of the collaborative partnership style of the clinic encounter.

Improving the degree to which patients adhere to their medical advice has a great significance for their health and the condition of the entire healthcare system. The age of a patient is one of many factors that determines adherence to medical recommendations. Control of competencies is one of the most decisive elements typical for the oldest and youngest crowds. High levels of satisfaction seem to deter patients from non-adherence to recommended treatment regimens. Additionally, the compliance of the youngest age group is mainly based on rational distrust. Meanwhile, the oldest patients’ behavior is solely dependent on the character of their connection with a doctor.

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Patient Motivation and Factors Maximizing their Compliance

Patient full adherence to long-term treatment strategies remains a challenging problem. A small proportion of patients follow the recommendations of their doctors today. It is essential to individualize the plan by taking into account the complexity of compliance. However, some systems and methods to increase compliance are:

1.Confidentiality; 2. Rapport and continuity of care; 3. Prevention of effects of adverse drug reactions on compliance; 4. Simplify the therapy regimen; 5. Self-monitoring; 6. Circumvent giving the dint that the drug replaces the need for changes in habits; 7. Distinguish the patient’s plan, understand the illness, and their importance and confidence about adherence; 8. Involve the patient in the clinical judgment; and 9. Motivational interview and negotiation is the intention of finding and addressing the factors and using appropriate strategies to create a unique environment that will induce patient motivation.

Photo by Rafael Bonilla on Unsplash

Human Behavior and Acceptance of the Suggestion

Suggestibility is the quality of being nodded to accept and act on the suggestions of others. The latter is typically the way hypnosis functions. It is the process of leading a person to respond uncritically, i.e., belief or action. It is the suggestion mode, while usually verbal, maybe visual, or may involve any other sense. One may fill in gaps in specific memories with false information when recalling a scenario or moment. Suggestibility uses cues to distort recollection: when the subject has been persistently telling something about a past event, their memory of the event adheres to the repeated message.

A person experiencing extreme emotions tends to be more amenable to ideas and, therefore, more suggestible. Generally, suggestibility decreases as age increases. Individual levels of self-esteem and assertiveness can make some people more suggestible than others. This finding led to the thought of a spectrum of suggestibility.

Three different types of suggestibility include Emotional, physical, and intellectual susceptibility.

Emotional suggestibility is characterized by a high level of responsiveness to inferred suggestions that affect emotions and restrict physical body responses.

On the other hand, physical suggestibility refers to the suggestible behavior portrayed by a high degree of responsiveness to literal instructions affecting the body and restricting emotional responses.

Intellectual suggestibility is the type of hypnotic suggestibility. A subject fears being controlled by the operator and is always trying to analyze, reject, or rationalize everything the operator says. With this issue model, the operator must give reasonable explanations for every suggestion and allow the matter to feel that he is mesmerizing himself.

The suggestion can turn and Tune in to the moment the physician is looking for; however, awareness is required to help patients identify the recommendations coming their way. If one isn’t aware of the messages you’re sending or receiving from others, it’s tough to counteract the negative suggestions they hear. So, tuning in to what’s going on around is essential.

Creating a network of support through Identifying the people that believe in us, and we can stay close. Both deliberate and non-deliberate suggestions perpetually influence us. Positive influence propagates encouraging suggestions. We must think about whom we spend the most time with and make sure that they bring positive energy to help create more positive outcomes in our lives.

By default, every human being is predisposed to maintain a rigid mindset. When we are locked into that state of mind, we all tend to take failure personally and recognize the little opportunity for improvement. Hence, as patients, we must continue to maintain a flexible attitude to alter behavior. The art of changing one’s behavior is to establish first the state of flexibility. With relaxed reflection, we continue to learn, grow, progress, and draw things into our life that will influence our progress.

It is essential to understand that the power of suggestion always works. Because If a patient expects some treatment to do if the doctor suggests specific results, then expectations of that outcome play a significant role in its happening. The expectation or suggestion alone often unconsciously vicissitudes the patient’s behavior and responses to help bring into reality the expected outcome.

Credibility as the Impetus of Human Acceptance of the Suggestion

One of the strongest determinants of perceived suggestibility is the credibility of the suggester. For instance, once a patient decides to visit a doctor’s office, often the research that particular doctor. Let’s not confuse this with popularity when that physician is perceived as good that a patient overlooks researching their credentials or credibility.

Credibility is a strong trait in the doctor-patient relationship and paves the way for better acceptance of medical advice and patient compliance. Generally, physicians have the challenging task of maintaining their professional image while adjusting to new perspectives; in the process, they encounter challenges of competency, consent, and productivity. Physicians tend to deal with these by performing different tactics, crafting pertinence, resonance, and substance to maintain a professional and confident appearance while seeking the information they need. If executed successfully, the tactics will enable the physician to reduce the anxiety linked with learning credibility tension and support his relationship with a particular patient.

Popularity is a Strong Tool for being Accepted

Popularity is the ugly cousin of credibility because many souls, whether conscious or unconscious, are confused between the latter two phenomena. While credibility measures a doctor’s trustworthiness, popularity is merely the state or condition of being liked, admired, or supported by the patient or any other person. Popularity doesn’t always equate with credibility because it has a strong vision subjective component. It has worked previously and will probably maintain its influence amid the mainstream in the future. Popularity makes it easier for people to accept suggestions from their idols, and usually, it is unconditional. We commonly witness the power of popularity within our political stage where famous politicians who know nothing about the healthcare system get elected to office based on a few baseless rhetoric’s, just because they have won their constituents’ confidence.

Personal Connection is Beyond Credibility

The Good, the bad, and the ugly of behavior are summarized in personal connection, credibility, and popularity. Credibility is an objective assessment of physicians’ competence to deliver exemplary medical service, but it is not always laidback for a layperson to precisely determine. Popularity is convenient yet risky and often manipulative. But Personal connection builds genuine trust between the two parties; hence it is more decisive than popularity. Nevertheless, a personal relationship requires more time and effort.

Popularity is the Risky Cousin of Credibility

Personal connection is an efficient and robust factor; that is why major corporations try to implement some form of end-to-end client experience. Within that context, they can “control” every aspect of how patrons interact with the company’s brand, products, promotions, and service offerings online. However, their vision of personal connection does not stop just there, as they intend to perpetually learn and manipulate the user suggestibility mindset to maximize profits. The latter accomplished easily using various Artificial intelligence tools and Deep learning methodologies. Moreover, most companies lack a strategic objective that spans the customer journey to be operationalized across the enterprise and increases customer value. Because they possess no exact genuine amount and Without such clear, measurable, value-creating goals.

Patients Already know Physicians are not Perfect, yet can Trust Them.

Breaking the barrier of suggestibility resistance is a big task for every physician looking forward to caring for patients. Hanging their licenses on the wall won’t help overcome that barrier if they can not build a trusting relationship. Patients already know that there is no perfection in medical care, but all they want is their doctor will do all they can to protect the most sacred asset of their lives; The Health.

The doctor-patient relationship is holy, as there is no relationship where the bond of trust should be that strong. Physicians need patients to be honest with them as much as they should see themselves. That is how they can provide the highest quality medical advice. Yet, there has been an erosion in the physician-patient relationship over recent years.

There is a loss of public trust in doctors, and not all are the doctors' fault. Third parties, including insurance carriers, are often making decisions, like dictating their own formularies. The physicians are restricted as to what medications they can prescribe. Outlier doctors, on the other hand, have been gaming the system, placing patients’ care first before profit. But there are a few who improperly use their medical degrees profiteering too.

Many mandates are imposed on medical doctors that affect patient care lOnof Electronic HeaOutlier doctors lth Records (EHR) and a Merit-Based reimbursement system. Based on the latter course, physicians are forced to document many metrics, inputting data into their EHR systems to meet requirements. Patients take this lack of eye-to-eye contact associated with physician engagement with data collection for insurance companies to sign that we are more interested in their digital records than them. They feel doctors are no longer listening to them without realizing that physicians are forced to function that way.

Concomitantly, HMOs have significantly cut reimbursements to doctors. For practices to stay afloat financially, physicians have to visit more patients. Patients feel this and indicate that we are pushing them through for profiteering and don’t care about them.

Media also portrays doctors as a bad influence in healthcare. There are ample stories about pill pusher doctors and those under arrest for fraud or harassment. There are many remarkable stories of valiant doctors around the bad apples. But the press intentionally fails to give them credit. That, too, tends to paint physicians all in a negative space.

The correct physician is not afraid of admitting to their imperfect sides. And generally speaking, patients perceive this as a sign of sincerity. When a valid physician can admit to a lack of enough knowledge about a patient’s particular problem, he would still direct the patient to the right expertise. Patients are understanding of such scenarios. It will not lower the physician’s credibility and maintain but enhance the suggestibility from the patient perspective.

Take-Home Message

Patients don’t change only by advising them because the bottom line of patient compliance is built on the complex nature of the doctor-patient relationship. What distinguishes such a relationship from the others is sympathy from the empathic interconnection built on the mutual collaborative base. Patients need lots of empathy and support to make their own decision. Meaning; sympathy is primarily used to convey commiseration, pity, or feelings of sorrow for someone else experiencing misfortune. At the same time, empathy implies the capacity or ability to imagine oneself in the situation, sharing the sentiments, ideas, or opinions of that person. Therefore, it is essential to realize that sympathy may have a paradoxical effect on patient advisability and compliance, as it may convey a sense of helplessness.

Personalized healthcare is a necessity for ensuring patient compliance. It is based on mutual trust, empathy, enhancing suggestibility on patients, and establishing reasonable credibility of the doctor, thus providing the optimal environment for a healthy life.

#personalizedmedicine #medical #healthcare #patientcare

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Adam Tabriz is a Physician, Writer, Entrepreneur, and public health policy, expert. He is an advocate for Personal liberty. The combination of his experience and expertise underlines his passion for advocating true “Personalized Healthcare” and “Healthcare without Borders.” His favorite slogan is: “Peace of mind would come to all people through the universal respect for the basic human rights of everyone”

San Francisco, CA

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