Why Your Doctor May Not Be The One To Push You To Change Your Health

All too often, people will recognize the need to make health changes in their lives, and then stop short. I see a doctor regularly, they think, I must be healthy because my doctor has not told me to make that change.
If you've fallen into this trap, it might be time to think again.

While we often blame time constraints on doctors for not getting the thorough care and even coaching we might desire, there is another element that is seldom considered in regard to how doctors may choose to encourage their patients to make change regarding their health. This element, often worse than the fear doctors have of doing too little, is pushing too hard (2014).1 "I wouldn't push that further because I don't want to lose her", is the non-academic sounding anecdote that tops a 2014 journal article on promoting behaviour change in the primary care setting for people with long-term conditions--like asthma .1

As a patient, this quote stopped me short. What do you mean you're not pushing your patients to be better?! Like with certain populations, such as high risk kids, I think about the reality that people grow to meet realistic expectations and grow through these experiences.
As a person with a background in health academically, however, I was less surprised.

Let's rewind and take a look at how, exactly, behaviour change works. Rewind. How starting or initiating, a behaviour change works and what has to be going on inside your head before you can even start making changes in your life. This applies from everything to exercise, to quitting smoking, to taking your meds as prescribed. These are known as the five steps to behaviour change.

  1. The Not-Even-A-Thought Phase, known as pre-contemplation. You have no interest in changing anything you do, don’t see a need to, and don’t even want to think about it. Essentially, if your doctor asks you to make a change in this phase, you’ll either remain with no interest in creating a behaviour change and you’ll just shoot them down, or you’ll move into the second stage.
  2.  The Hmm Maybe… Phase, otherwise known as contemplation. You realize that you should make a change in your health choices, but aren’t interested in doing it at this point in time. Maybe in about six months, but not now. If your doctor brings up changes you need to make during this phase, you’re more likely to consider them as a worthwhile thing to think on.
  3. The I’ll Start Determining If That’s a Good Idea Phase, or the preparation phase. You’re about ready to seal the deal and start taking action, but, maybe you need to chat with your partner or doctor or buy a new pair of shoes or find an accountability partner. And if any of these things are too hard, slipping back into just thinking about it (see: contemplation) may be a reality. If your doctor is involved, they’re likely to maybe have a couple tips to help you be successful in making asthma or health related changes.
  4.  The I’m Ready Phase, or, action! You’ve got your plan in place, and it’s time to follow it. This is where you’ll start seeing the impact of making the change in your world. You may need support from your doctor to keep you motivated, or the feedback of test results to show you that the change being made is worthwhile from both a clinical standpoint as well as your own, or you may just feel good about the power you have over your circumstances.
  5. The I’ve Got It Phase—hello, maintenance. You’ve made your plan, followed it, and stuck through with it. You’ve adopted the behaviour you want and have seen what good things have come of it. Your doc may check in every so often at appointments to see if you’re keeping up on the changes you’ve made, or if you’re having any problems to troubleshoot.

So, you can see how depending on where you’re at… Your doctor may or may not have a lot of push in motivating you to change your behaviour—it’s about both of you: your mindset and their knowledge. If you have zero interest in taking your meds, your doctor can’t make you. However, if you’re kind of interested in say, eating better to control your weight and reducing the effects of obesity on your asthma, and your doctor suggests you try it, you may be more apt to continue exploring creating that change. The bottom line: If you want to change, it’s about you—start the conversation if you need to!

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