How the family doctor helps with behavior changes

An important role for family physicians is helping patients through behavior change. Using change interventions is especially helpful when it comes to addressing lifestyle modifications necessary for disease prevention, long-term disease management, and addictions. In addition, understanding each patient’s readiness to make the necessary changes, appreciating the barriers to change and helping patients anticipate relapse improves both patient satisfaction and lowers physician frustration during the process.

Regardless of what the change is, be it exercise programs, stress management techniques, or dietary restrictions patient motivation is required. Changes in patient lifestyles are necessary for successful management of long-term illness. Moreover, relapses of these ailments are often attributed to lapses in healthy behavior by the patient. While most patients understand lifestyle modifications are important to overall long term good health, consistent, life-long behavior changes are difficult. Therefore, the role of family physicians to assist patients in understanding their health and to help them make the changes necessary for health improvement becomes more difficult.

On occasion, doctors will see a patient who has experienced a medical crisis or has completed a health assessment and was advised to change poor behaviors, readily comply. However, the more common scenario is that physicians encounter patients who seem unable or unwilling to change. Medical practitioners can assist by taking specific action and acknowledging that changes in behavior occur gradually and relapses are almost inevitable and should, therefore, become part of the process of working toward lifelong change.

There are five stages that most people must pass through in order to complete a behavior change. Known as the Stages of Change model, it shows that, most people change their behavior gradually. It begins with the patient moving from being uninterested, unaware or unwilling to make a change in the stage known as precontemplation, to considering a change in the contemplation stage. Next, the person will decide and prepare to make a change before genuine, determined action is taken. Over time, several attempts to maintain the new behavior will occur and relapses are pretty much inevitable and should become part of the process of working toward lifelong change.

In order to do so, a doctor needs to identify a patient’s position in the change process in order to be able to tailor the intervention with skills they already possess. Therefore, the focus of the office visit should not be to convince the patient to change behavior. It should be to help him or her move along the stages of change and the goal for a single encounter is a shift from the getting the patient to change an unhealthy behavior to identifying the stage of change and engaging each patient in a process in order to move to them to the next stage.

In other words, the doctor should view the meeting as an opening health and risk assessment of where patients are in the behavior change process and patient’s response to direct advice can help the doctor plan for the next step in the physician-patient dialog. Therefore, rather than merely educating and admonishing, doctors can tailor interventions to each patient in order to enhance success.