Reframing the first step

Editor’s Note:Physicians Practice’s blog features contributions from members of the medical community. These blogs are an opportunity for professionals to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions are that of the writers and do not necessarily reflect the opinions of Physicians Practice or UBM.

I am reading an interesting book about behavior change called Switch: How to Change Things When Change is Hard by Chip and Dan Heath. Since I am in a constant state of trying to change everyone’s behavior around me, I find the science behind behavior change fascinating. I won’t ruin the book for you, but there was one part of it that I found particularly intriguing. The upshot of the research cited is that if you can convince people they are already part of the way to the destination (wherever that is), they are more likely to complete the journey (i.e. change). I liken it to the difference between the feeling of climbing 1000 feet from the bottom to the top of the mountain and the feeling of reaching the halfway point and realizing there is only 1000 more feet left to climb.

I’ve considered how I can introduce this concept to my patients and help to cognitively reframe things like A1C control, weight loss, medication compliance, or even coming in for a visit. Generally, my conversations go like this:

Me: Your A1C is above your goal. This concerns me because it puts you at risk for complications from diabetes.

Patient: Hmmm…what should I do?

Me: Well, I think we should start a second medication, and I’d really like you to go to diabetic education to learn about what you should be eating.

Patient: Sounds like an awesome plan, count me in! 

Just kidding. It’s never that easy. Usually, it goes more like this:

Patient: Okay, do I really need to start another medication? I don’t like medications. Plus, I already know what to eat. It’s just hard to do because of my schedule.

Starting next week, I’m going to take a page out of Chip and Dan’s book and try this:

Me: You’ve done such a great job getting your A1C down from 9.8. You’re most of the way there, but it is important we get it lower to prevent complications from diabetes.

Patient: Hmmm…. what should I do?

Me: Fortunately, you are already taking one of the best medications for diabetes and have done well on it. Many patients need to take two medications to control their diabetes. So, you’re already halfway there. I think we should start a second medication. Also, I know you’ve seen the diabetic educator once, and I think finishing the classes would give you important information.

Patient: Sounds like an awesome plan; count me in!

I’ll have to let you know what percentage of my patients enthusiastically endorse my recommendations. Seriously though, this concept intuitively makes sense. The first step is often the hardest. What if, for our patients and ourselves, the first step was over before we ever began?

Jennifer Frank, MD, is a family physician and physician leader in Northeastern Wisconsin and finds medicine still to be the best gig out there. Married with four kids, she is engaged in intensive study and pursuit of work-life balance.