Any medical intervention is only as good as a patient’s willingness to follow it. This is especially true of dietary and lifestyle changes aimed at preventing chronic and deadly health problems like cardiovascular disease, insulin resistance and diabetes.
Getting patients to make long-term lifestyle changes is arguably the biggest challenge facing medical practitioners regardless of their educational backgrounds and medical specialties, or the types of treatments they offer.
Noncompliance is endemic in conventional medicine. Various studies have shown that 20%–50% of patients fail to appear for scheduled appointments, 20%–80% make errors in taking medication, 25%–60% stop taking medicines before the prescribed course has been completed. For lifestyle changes, the problem is even greater: up to 80% of patients drop out of lifestyle-change programs (Turk, et al., “Adherence: A Cognitive-Behavioral Perspective,” in Compliance: The Dilemma of the Chronically Ill, KE Gerber, AM Nehemis, eds., New York: Springer, 1988).
The principles of naturopathic medicine have much to offer in helping patients help themselves. Here are a few strategies that I’ve found helpful in working with my patients:
Spend time with your patients: Develop a relationship with them, and try to adopt the position of health coach. Make eye contact, adopt a relaxed posture indicating interest, and verbally follow the patient with active listening, paraphrasing or summarizing what they say to you in terms of both the stated factual content and also the feelings expressed.
Encourage diet/exercise diaries: When introducing dietary and lifestyle changes, have the patient keep a diet and exercise diary, and return with it on a regular basis to fine tune diet changes, reinforce positive changes, and give the patient a sense that someone is “looking over their shoulder” in a supportive way. At the same time, empower the patient to take personal responsibility for as many of the factors influencing health as practical. When the patient is a partner in the treatment plan, they are much more likely to adhere over the long term. Don’t ask too much of a patient all at once, and make changes incrementally.
Recognize that not all patients are ready or willing to change: Until they are, medication may be a better option. For these patients, keep the door open for them to accept their role as a full, active participant.
Remember relaxation: In addition to diet and exercise, relaxation has also been shown to lower lipid profiles. Relaxation exercise, meditation techniques, or guided imagery should also be part of the plan, and this often opens patients to self-reflection that may enhance their motivation to make lifestyle changes.
Acknowledge the difficulty: Remember that lifestyle changes require patients to go against long-standing habits. New health-promoting behaviors invariably disrupt an individual’s settled patterns, and it may take them a long time to feel comfortable.
“Adherence,” not “compliance” : Bear in mind that “compliance” connotes conformity and acquiescence to an authority, while “adherence” suggests that the patient is self-motivated and choosing to carry out an agreed-upon treatment. Try to use the latter term whenever possible.
Check your own attitude: A patient’s adherence to a lifestyle intervention is greatly influenced by 2 factors: the degree to which the patient is satisfied with the physician, and the way the intervention is presented and then supported by the practitioner. In other words, your own attitude toward both the patient and the suggested intervention will have a big impact on the outcome.
Titrate information carefully: Research shows that patients forget much of what they are told, and the more they are told in any one visit, the more they forget. Writing things down does not necessarily improve recall. On the other hand, the more medical knowledge a patient possesses to begin with, the more s/he will recall. Patient education is essential, but tailor your approach to the knowledge level of each individual patient.
Take to heart the eloquent words of Albert Schweitzer: “Each patient carries his own doctor within. They come to us not knowing that truth. We are at our best when we give the doctor who resides within each patient a chance to go to work.”
Michael Traub, ND, is immediate past-president of the American Association of Naturopathic Physicians. He practices in Kailua-Kona, Hawaii, and is on staff at North Hawaii Community Hospital.
