You heard me correctly.  Do not go to your next doctor’s appointment.  I repeat, do not go.  Do not pass go or collect money.

Now that I have your attention, you may be thinking what is this crazy doctor saying? If I had a dollar every time a patient came in and asked for my advice but didn’t follow it, I would have been retired long ago.

Why is this?

Change takes time.  It takes a patient who is not only willing but also ready to change.  And once ready, it takes 3 to 4 weeks or longer to fully implement any single change into our lives.

So why do you go in and talk to your doctor about your headaches but are not willing to wean off the caffeine or talk about your functional (non-disease related) abdominal pain but are unwilling to change your diet?  Do you like to waste your time?  Ours?  I know this is not most patients’ intent.  It all goes back to this: change takes time. I have been guilty of putting off necessary change myself.

Usually when the acute symptoms of headache or abdominal pain subside, so does one’s urgency to address them.  Our busy lives are often governed by things that are urgent leaving us little time to tend to things that are important but not urgent.

All of the above thoughts have been playing in my mind since two things occurred.  The first was when an elderly patient came in complaining of constipation.  I gave him my usual spiel. The same spiel I had given for years.  This particular patient wanted to schedule a follow up in case he wasn’t improving.  On follow up, his constipation had completely resolved.  I asked how long did that take. He replied, “two days.”  I asked how did he do it.  He said, “I did everything you said.”

Many times, we as physicians do not hear back from the patients who get better by following our advice.  This can make it seem as if all the counseling we do is ineffective.

The second instance was while collaborating with a good friend who is a health coach.  She counsels people holistically on how to be healthy which includes how to eat healthy.  All of her clients lose weight.  Yes, all of her clients lose weight.  We compared what we told our patients.  We said similar things.  So why am I as a physician ineffective in getting people to change and lose weight?

One key difference between our patients is that those who seek the services of a health coach are often willing and ready to change.  You would hope they are if they are willing to pay out of pocket to see one.  Whereas when a patient sees a physician it is often times related to an abnormal lab or blood pressure, which requires a lifestyle change that a patient is often times not ready to make.

Is the above my excuse? Can anyone make a person change? I used to think that it was all up to the patient and that there was nothing I could do. Now, I will strive a little harder to motivate my patients to get to the “ready” stage.  I want to do better.

Before your next doctor’s appointment ask yourself this: “Am I willing and ready to make a change?”

And I will ask myself how can I motivate patients to get to the next level.

Rajka Milanovic Galbraith is a family physician who blogs at Expat Doctor Mom. 

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