Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (1)

Changing Patient Behavior: Two Power Words

“I recommend.” These are two word which, when spoken by a physician to a patient have tremendous power to change behavior. That assumes of course a trusting relationship between patient and physician (but that’s a topic for another day.)
 
Take the colonoscopy. The U.S. Preventive Services Task Force (USPSTF) recommends that adults aged ≥50 years get a colonoscopy every 10 years. In 2005, 50 percent of adults aged ≥50 years in the U.S. had been screened according to these recommendations. Not surprisingly, the rate of colonoscopy screening is much lower than that of other recommended adult preventive services. I was curious: Why?
 
Here are two interesting facts:

1. Studies show that patients cite “physician recommendation” as the most important motivator of colorectal screening. In one study, 75 to 90 percent of patients who had not had a colonoscopy, said that their doctor’s recommendation would motivate them to undergo screening.

2. In that same study, in 50 percent of patients where a colonoscopy was appropriate but not done, the reason given was that the physician simply did not “bring up” the subject during the visit. Reasons included lack of time, visit was for acute problem, patient had previously declined or forget.

What The Doctor Says Makes A Difference
 
Turns out that the highest colonoscopy screening rates were highest among physicians who were more adamant about the need for screening. These doctors framed the recommendation (message) to the patient as coming from them self, e.g., “I recommend” or “we recommend.” Doctors who framed the recommendation as coming from someone else, e.g., “they recommend” or “organization X recommends” had lower screening rates.
 
The following table provides examples of the differ ways that physicians in this study framed their recommendation to patients for colorectal cancer screening:

A Word Of Clarification
 
In these days of patient-centered care and shared decision-making, some may question the use of physician-centric directives like “I recommended.” For one thing, a strong physician recommendation is what some patients want. For patients who want more than just the physician’s recommendation, the physician can provide them with information to help them make their own informed decision about getting a colonoscopy.
 
I recommend that you give this approach a try!
 
Resources:

Levy, B., et al. “Why Hasn’t This Patient Been Screened for Colon Cancer? An Iowa Research Network Study.” Journal of the American Board of Family Medicine. 2007;20:458–468.

Guerra, C., et al. “Barriers of and Facilitators to Physician Recommendation of Colorectal Cancer Screening.” Journal of General Internal Medicine. 2007; 22(12):1681–8.

*This blog post was originally published at Mind The Gap*


You may also like these posts

Read comments »


One Response to “Changing Patient Behavior: Two Power Words”

  1. Here’s why I recommend…

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »