How can we understand when patients or clients don’t change a behavior that we think is critical for them to change? For example, the person whose diabetes is out of control, the smoker who has emphysema, the person with high blood pressure who won’t take their medication.
To understand this, I encourage you to think about a time when you were asked to change something in your life, something important to you. Were you sure you wanted to change? Where you sure you were able to change?
When I was learning MI, I had an experience that really taught me how this works for our patients and for us. I come from a family with a long history of heart disease and diabetes. I have many of the risk factors, including high blood pressure and high blood cholesterol. As I approached age 50, the age at which my father developed diabetes, I began to wonder if this would happen to me. At age 60, it happened. My doctor called to tell me that I’m “pre-diabetic”. She wanted me to see a dietitian (!!) I reminded her what I do for a living….
She suggested I be a patient, not a dietitian. I went to see the diabetes educator she recommended. I was determined to do EVERYTHING RIGHT and be the perfect patient. I increased my physical activity and “tuned up” my diet. I checked my blood sugars, kept records, and did everything else suggested. All of this happened during the summer, when my work slows down and I have lots of time to do these things. I saw my doctor in September, and I had done it! The long term measure of blood sugar was in the normal range, without medication. I was thrilled.
In the fall, when my teaching, training, consulting and private practice become busy again, I struggled to continue to keep up this effort. Over several months, I began to understand how this would work. When I am busy and traveling for my work, I am not able to keep up the level of effort with my diet and exercise that is necessary. My work is very important to me. It is one of my core values, and I am not willing to compromise it.
So, I learned that while I want to do these things, I am not able to and still have my work life the way I want it. I decided to take the medication for blood sugar that my doctor recommended, and do my best with my lifestyle.
My point here is that our patients feel the same way. While they might want to do what we suggest, they might not be able to. Our job is to help patients make decisions about how the changes you propose will work in their own lives, and support them in these decisions.
