Can Physicians Effect Behavior Change During Office Visits?

Wednesday, October 7th, 2009
This post was written by Melanie Matthews

Kristin S. Vickers Douglas, Ph.D., L.P., clinical health psychologist and medical director of Mayo Clinic’s EmbodyHealth program, discusses whether an office visit delivers enough time to effect behavior change in a patient.

Question: Does the brief duration of the typical physician-patient encounter allow enough time for a physician to effect behavior change?

Response: Powerful things can happen in seconds. Think about practicing motivation enhancement, relationship-building and patient-centered care, and embedding that in everything that we do, even if it’s taking vital signs. Make sure that you’re listening and positively reinforcing anything that a patient is doing, paying attention to how you talk to an individual and help elicit change talk. It’s important that physicians are practicing this patient-centered relationship-building. Research shows that not only is this a positive outcome in terms of patient satisfaction with the physician relationship, but also that it drives important outcomes, such as patient health status and adherence to medical recommendations, if the patient rates the relationship as positive and collaborative.

Physicians are aware that this goes beyond the nice extra of having your patients like you. These relationship skills are important and can be embedded within every second that they’re talking to the patient. There is compelling evidence about the feasibility of building in everything at the point of care that is physician-delivered. We need to have models of care, and this is happening across chronic conditions, diabetes, asthma and now even depression. There is emphasis in getting care teams that involve roles such as care managers — who have also been called health coaches — to extend beyond the patient-physician encounter. That is the work of collaborative goal-setting — identifying the next step and then having the critical follow-up to see how it goes. Setting a goal is one thing, but learning from that experience and figuring about where to go from there is perhaps the more important step. There’s a recognition that our current systems aren’t set up to do that within a patient-physician encounter. I’m excited to see that there are even reimbursement changes from third-party payors to start to help support these shifts in care. It all goes back to lifestyle. What happens outside of the physician’s office drives so much of gaining health and maintaining health.

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