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With the pandemic almost under control (somewhat), the COVID headlines need to be replaced with “We are in a serious health crisis”. In practice, motivating even the most stubborn patients can be a job in itself.  How often do you offer up advice to gently nudge your patient in a healthy direction?  I do it daily, and instead of becoming frustrated, I have changed my line of questioning, and with the final conclusion being the patient has the ultimate choice in their health.
Motivation to take control of one’s health is just that:  a choice one makes due to different motivations.  Some people are motivated by external pressures from family, friends or work groups.  This is seen as a deficiency type of motivation where the patient views themselves as lacking in their life.  This often presents as “I should do …”.  When working with these patients, it’s helpful to expose the outside pressure source, and allow the patient to question how they want to respond to this outside pressure. This provides an opportunity to remind the patient that the quality of their health is their choice.  The most familiar type of motivation for most, however, is threat-based motivation.  Most of us are familiar with anti-smoking campaigns, childhood health education, and any other type of fear-based pressure.  Most of the population knows that smoking and eating fast food is not the best for us, for example, but we also know that these attempts to scare people into compliance generally has the opposite effect and are largely ineffective.
While this is great information on how people are motivated, it doesn’t say much about how we go about motivating people with whom we work.  This begins with acknowledging that making positive health changes is a choice.  For some of our patients, visiting their acupuncturist may be their single effort towards better health (Yay!).  Acknowledging this effort with the patient is crucial for both building trust, and for setting future health goals.  During the initial patient interaction, I’ve seen a lot of success in setting goals with patients and revisiting them every 6 visits.  These goals can be as simple as “I’d like to walk around the block without great effort” or “I’d like to be able to play golf again”.  Or, more complex like “I’d like to lower my blood pressure to avoid medication” or “decrease my fibromyalgia symptoms”.   While setting these goals with patients, encourage them get into the nitty gritty of what that goal looks and feels like to them. This method allows the patient to attach an emotion to their goals, exposes the discomfort felt by their issue, thus switching the motivation from external sources of pressure to very personal feelings and emotions.
Once this emotion-based goal setting is in place, it is somewhat easier to incorporate it into each treatment plan and patient contact.  You, the practitioner, are influential in the health of your patients. Not just in your expert treatment, but in your encounter and conversation with your patients.  Posing questions at the end of treatment reminds patients that they need to participate in this health relationship.  For example, “you’re planning on walking halfway around the block this week?” They have to answer your question and saying “No” is uncomfortable. And, by answering “Yes” they’ve agreed to participate.
Motivating your patient in healthy living is a huge task and responsibility.  Finding ways of encouraging patients to set and visualize goals in a meaningful way, may increase compliance and participation in their health goals.  You are one of your patient’s greatest influences in health!
We thank Dr. Jennifer Rysanek, DOM, NMSAAM Secretary and Membership Chair, for writing and submitting this article.

Please note: This article expresses the opinions and research of the author, and does not necessarily reflect the views or policies of NMSAAM, the NMSAAM BOD, or the ASA.