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How do you steer people away from trouble?

From time to time you will notice that your customer, client or patient is taking risks. How do you hope to steer them away from trouble? It’s more than what you say because information alone does not change minds.

It’s probably happened more than once: You spend a lot of time trying to convince someone that their opinion on a particular issue is wrong. You take pains to make sure your argument is air-tight. But instead of coming around to your point of view, your conversation partner pushes back, still convinced of her ultimate rightness. Elizabeth Svoboda 

In healthcare when people are overweight, smoking, drinking too much or have other risk factors for longterm illness it may be helpful to know who to try to advise. Not everyone is ready to change. In practice few practitioners give much thought to ‘who’ is ready.

In addition you might want to consider when to attempt to broach the subject:

Think about an event, an insight, an experience, a conversation that forever changed how you are or how you operate in the world. Although a small minority of people might mention something that happened in therapy, or a classroom, or formal learning experience, the vast majority of cases occurred after recovering from a challenging or even traumatic event—the death of a loved one, a major failure or disappointment, a crisis or catastrophe, a relationship or job ending, a threatening illness, or something similar. Jeffrey Kottler

You might want to ponder where people are most often open to review their ideas.

My favorite saying, obtained from Dr. Primack’s office, is “What you do today is important, because you are exchanging a day of your life for it”. So make it count, and learn how to be the best you that you can be. Swanson and Primack

Finally and perhaps most important- how you will attempt this most challenging of manoeuvres.

  • Many patients who smoke are sceptical about the power of doctors’ words to influence smoking since most know about the dangers, make their own evaluations, and feel that quitting is down to the individual
  • Opportunistic antismoking interventions should be sympathetic, not preaching, and centred on the patient as an individual
  • Repeated ritualistic intervention on the part of doctors may deter patients from seeking medical help when they need it
  • Smokers can be categorised as “contrary,” “matter of fact,” or “self blaming” in their reaction to antismoking advice
  • Doctors can tailor their approach according to the type of patient.

Butler et al BMJ

Whatever you do it does warrant some thought. In healthcare the stakes couldn’t be higher:

Current public health policy stresses the potential of cumulative, small changes in individual behaviour to produce significant advancements in population health. The Behavioural Insights Team or ‘Nudge Unit’ advocates for changes in health behaviour through manipulations of small environmental cues. The movement in the National Health Service (UK) to ‘make every contact count’ recognises the opportunity that practitioners have to improve public health through supporting behaviour change in the millions of people with whom they come into contact. It seems an appropriate moment to harness recent advances in behavioural science in the battle against the rising tide of Non Communicable Diseases threatening to engulf us. Kelly and Barker

Picture by send me adrift

How do you prepare for work?

I don’t know him personally but I don’t imagine that Michael Phelps dives into a pool when he isn’t ready to race. Similarly Usain Bolt might look like he jumped off the viewing stands and popped himself on the starting blocks but in truth his mind and his body are ready to make him the fastest man on dry land. However when we arrive at work we might still be thinking about the argument at home, the traffic jam or the news. We might arrive a bit disheveled, a bit breathless or a tad tired. We might not hear the first few things we are told or notice more than we can take in at a glance of our first customer client or patient. However to perform at our peak we might consider what might get us in the zone so that our performance is not in question.

Picture by Jörn Guy Süß

Do you advise or dictate?

What do you advise most people who seek your help? What will solve most of their problems? It was interesting to read an article this week suggesting that junk food may be associated with depression. In her commentary Megan Lee notes:

Depression has long been treated with medication and talking therapies – and they’re not going anywhere just yet. But we’re beginning to understand that increasing how much exercise we get and switching to a healthy diet can also play an important role in treating – and even preventing – depression.

For many of the most coveted outcomes in healthcare three things are paramount:

  1. Eat less
  2. Exercise more
  3. Don’t smoke

Simple focus. Not easily translated in practice because selling a healthy lifestyle is tricky:

Interviews with 130 mothers of lower social class provided the basis for studying their views on the desirability of general practitioner intervention in their lifestyle habits; the study used both quantitative (questionnaire) and qualitative (interview) techniques. The majority of women were in favour of counselling on specific topics by the general practitioner but the qualitative data also revealed that most respondents expected the issues to be relevant to their presenting problem. Moreover they were keen to assert their right to accept or reject the advice given. Stott and Pill

Picture by Fit Approach

Trust me

Is there anything about how you appear today that might reduce your credibility with your client, customer or patient? Does anything about you diminish the impression you’d like to create?

A majority of participants reported that wearing an easy to read name tag (77%), neat grooming (65%), and professional dress (59%) were important when first meeting a family member’s ICU physician, while a minority felt that physician sex (3%), race (3%), age (10%), absence of visible tattoos (30%) and piercings (39%), or wearing a white coat (32%) were important.

Third, we affirmed that regardless of dress, professionalism, neat grooming, and a clear name tag are perceived as a requisite by patient families. These results suggest that while families may not express preferences for how physicians dress, there may be subconscious associations with well-recognized physician uniforms including white coats and scrubs. Given the importance of effective communication in the ICU, physicians may want to consider that their attire could influence family rapport, trust, and confidence. Selena Au

Picture by Rodrigo Santos

Do your words strike a discordant chord?

Most upper respiratory tract infections are caused by viruses. However saying that to a parent with a sick child doesn’t always help:

Parent 2: They think they make you feel better saying it’s a virus…but they make you feel worse

Parent 7: When they say it’s a virus, I mean what kind of virus? Just where does it come from? Parent 1: You’re none the wiser how they got it, what you can do, how long it will go on…

Parent 5: You feel you’re no further forward…you just have to accept it if they don’t explain further, I would like to know…

Parent 2: It’s an unknown thing to a doctor, they can’t pinpoint it, they don’t know really…

Parent 1: I feel a bit annoyed really because you think they’ve studied for years to learn that and I haven’t studied at all, you feel dissatisfied as if you wanted to hear something more…you just wish that everything was clean cut

Parent 4: At least if you really knew what it was then it’s easier to cope with (Group 3) Joe Kai BMJ 1996

What do you say in these circumstances?

Picture by Massimo Variolo

Do you bring more than your body to work?

Things happen at home. They happen now and they happened in the past. A child gets sick, a parent dies, a partner leaves you, a bill is overdue, a neighbour causes hassle. You end up in hospital, you get a parking ticket, you win a prize, you get picked for a team, your application gets rejected . Good things, bad things or just ‘things’. Be honest- how much of this plays on your mind as you serve your next customer, client or patient? How do you handle that? Do you take the backpack off before you get to the office, clinic or shop?

Picture by Neil Moralee

Steep hill but nice view

On this beautiful earth it is not long before you have to climb a hill to enjoy the view. Where in your job is extra effort required to get to the end of the day? What makes it harder? Could it be the voice in your head telling you that this particular ‘hill’ was specifically designed to make life harder for you? Is it because you were not anticipating any ‘hills’. Are you on the wrong road? Do you need to get fitter? Is hill climbing not for you? Could it be that the view is not worth the effort?

Here’s a perspective from Jonathan Mead

Picture by  Tejvan Pettinger

Why do you care?

People like to know about their healthcare professional. Do you have a brief story about how it all began? Consider the setting? The year, the circumstances in which you set off on the path. What was the challenge? What issues or circumstances made you feel less sure of the path you were on at the time? What was the turning point? What chance encounter or experience ultimately made the option you chose the right one?  How do you feel about what you do? It shouldn’t take more than two minutes, if that. Rehearse the story.

Picture by Björn Engqvist

What do you share about yourself that’s a safe topic?

Health warning:

As a doctor, the reality is you are never off duty and their status in the public eye demands a high standard of conduct at all times. Dr Naeem Nazem 

At some point someone will ask you where you went on holiday or why you have a model airplane on your shelf. You can choose to be very ‘private’ or have something you might find increases the connection with that person without befriending them on Facebook.

Physicians aged 40 to 59 years report that they most enjoy running or jogging (36%), bicycling (35%) and camping or hiking (24%). About 50% of physicians older than 60 years reported walking to stay healthy.  Other interests include golf, aerobics and cardio, skiing, tennis and fishing. Other leisure activities reported include reading, with many physicians describing themselves as avid readers; regular reading was reported by more than half of physicians under 40 years, 58% of those aged 40 to 59 years and more than 64% of those aged 60 years and older. Endocrinology advisor

The trick is not raising topics that should be off limits but it makes you more human if your client, customer or patient knows you are an avid reader, you play golf or sing in the choir. You can prompt the chat by having a prop for something that you are happy to share. My doctor has a picture of a civet cat in his room. I’d love to know why,  he tells me everyone asks him about the cat.

Picture by  Daniel Colovini  

Are you worried they’ll never stop talking?

It’s a busy day at work and the next customer, client or patient settles in to tell you something. Are you secretly asking yourself:

 How long will this take?

Will it pay off allowing them to take a couple of minutes to speak about whatever’s on their mind? Have you tried it and timed how long before they stop?

Studies have even shown that participants are willing to give up between 17% and 25% of the monetary reward offered for talking about others in order to feel the intrinsic rewards of talking about themselves. And outside of the lab, 40% of our everyday speech is devoted to telling other people how we feel or what we think. That’s almost half! Belle Beth Cooper

So if you want to do something special for your client, customer or patient give them a chance to say what they want- you might be surprised that it doesn’t take that long and pays enormous dividends.

Picture by Stiller Beobachter