What does it take to help patients change behavior?

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I haven’t said much about it over the past few months but I’ve been working with QuantiaMD — a web site for health care providers — to answer provider’s questions about how to work better with diabetes patients. As you might imagine most of the questions had to do with behavior change: “How do I help my patient eat healthier?”; “Why does my patient start doing better, like taking their medicine and exercising and then just stop?”

So I’ve been teaching some basic principles of behavior change and coaching in three presentations, with four more to come, and I thought it time to share. 

1. “Rapport before report”: This first presentation is about seeing the patient in front of you, not just their numbers.

2. “Why patients don’t change behavior and what you can do” : In my second presentation I discuss whether patients have the correct information? Do they understand what to do? Do they have the skills they need? And does fear stop them?

3. “Three more reasons why patients don’t change behavior and what you can do”: In this presentation I talk about the importance of patients choosing the behavior they’ll change, whether their motivation not to change is greater than their motivation to change and does their environment support the change? And there’s a last reason: Do you as a health care provider model the change?  

Unfortunately we know most doctors today will treat more patients with chronic illness than acute, and most doctors are not trained how to do so. I’m honored to have the opportunity to address all those who help to keep us well. 

To view the presentations, you’ll be prompted to register on QuantiaMD, but it’s free and the presentations are each about six minutes long.

So pour yourself a cup of tea, pull up a chair and open your mind to the possibilities of doing a few little things that can deliver powerful results. 

Bridging the gap between patient and provider

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I’m part of a new service being offered by QuantiaMD called “Ask the Patient.” I’ll be answering health care provider’s (HCP) questions about what it’s like to live with diabetes, and how they can help their patients achieve better control and make healthy behavior changes. Given the strong emphasis on cut and cure in medical training and bare mention of behavior change, here’s an opportunity for providers to understand how to turn on a patient’s desire, skills, hope, and enthusiasm to take care of their diabetes. 

Here’s my page which consists of a 3 minute introduction of myself, explanation of the service and a call for questions. After questions are submitted I’ll my answers will be presented in a follow-up video.  

The service is available only to HCPs so patients will not know what you are asking. All you have to do is sign up.Members can access QuantiaMD for free through any smartphone, tablet or computer.  

If you are a health care provider, or know of someone you think this would benefit please pass this along. Having patient-experts as resources to help HCPs better understand what we deal with is to me a fantastic idea, and a brilliant way to help both patients and health care providers achieve better outcomes. 

Ask the Patient

A new doctor-patient relationship feature coordinating an active conversation between health care providers, and selected patient experts, exclusively on QuantiaMD. Through Ask the Patient, QuantiaMD is bringing the patient’s perspective on engagement, chronic disease, medical errors and many more topics to their community of clinicians. QuantiaMD is a medical learning network where HCPs connect with and learn from knowledgeable patients eager to share their experiential wisdom. On QuantiaMD, physicians learn about clinical advances from expert faculty and connect professionally to better manage their practices, support their patients, and take care of themselves. 

A New Tool to Motivate Patients’ Self-Care


Well, here’s one for the diabetes professionals, educators and nurse practitioners–although as a patient you may learn something too. July 26th at the Marriott East Side Hotel in mid-town Manhattan I attended Dr. William Polonsky’s seminar, “Understanding Behavioral Change to Help Improve Diabetes Outcomes,” which he delivered to more than 120 diabetes professionals. You can look here forfuture programs

Dr. Polonsky is a noted figure in diabetes, in fact I started this blog talking about him. He’s a psychologist, diabetes educator, Associate Clinical Professor of Psychiatry at the University of California, President and Founder of the Behavioral Diabetes Institute (BDI) in San Diego, the only institute looking at the emotional side of managing diabetes. He’s also the author of several coping with diabetes books. The program he’s created helps practitioners identify and address their patients’ psychological hindrances to self-management. He identifies 7 “Tipping Points” — tipping points being those hindrances that get in patients’ way–and helps educators coach patient’s through them tipping them toward better self-care. Invariably, if you work with patients you will recognize these among your patient population. If you’re a patient, you may just notice one of these emotional blocks applies to you:

1. Depression, which can be tipped toward a positive, engaged outlook on life

2. It’s no big deal, which can be tipped toward recognition of personal risk

3. Inevitability of complications which can be tipped toward hope

4. Treatment skepticim which can be tipped toward a realization that treatment can work

5. Unrealistic action plans which can be tipped toward clarity of action

6. Poor social support which can be tipped toward optimal social support

7. Environmental pressures which can be tipped toward new, effective ways of coping with stresses

The “tipping” is done by helping patients address their underlying emotional or psychological block or wrong-thinking and through inquiry and coaching getting to the root of the block and helping patients see a more positive outcome, this helps them get more invested in managing their diabetes.

Polonsky went for a laugh first by asking his audience, “How many of you have run into a patient in the last month that wasn’t taking perfect care of himself?”  He to the expected response as laughter spread across the room. He then told us that no patient is unmotivated to live a long and healthy life although sometimes it appears that way; the problem is that taking care of diabetes often doesn’t seem very rewarding. Imagine an educator saying to a patient, “You know Mrs. Smith if you take this medication I’m prescribing, see a battery of doctors regularly, get an A1C test every three months, watch what you eat and exercise every day, check your blood sugar all the time and do this 24 hours a day the rest of your life, here’s what’s in it for you — Nothing! If you’re lucky nothing is likely to happen.” It takes a lot of motivation for the average patient to perform the over 150 (they were counted by diabetes educators) self-care tasks day after day after day just to maybe not have something bad happen, maybe.

Polonsky’s course, sponsored by Roche, gives healthcare providers resources, training and support to help them identify and evaluate their patient’s tipping points and address them to create partnered, meaningful treatment plans. If you’re an interested healthcare provider, you’ll find more information here and on the BDI web site. If you’re a patient take a look at his brochure on the BDI site: The emotional side of diabetes: 10 Things You Need to Know. It’s a reassuring read, especially if you notice you may have a tipping point of your own