In the “olden” days, doctors gave orders: “Take these medications, start exercising and go on a diet.” If patients failed to follow through, they were labelled as “non-compliant.”
That term literally meant that the patient did not bend to the will of the doctor, and since MDs are neither gods nor psychic surgeons, that should not be our goal at all.
The term, noncompliant, has now been replaced by the somewhat better term non-adherent, which means the patient did not stick to the plan.
We now recognize the majority of an individual’s medical care is his or her own responsibility – what is done in the huge expanse of time between medical visits: habits, physical activity, diet and the taking of medication. We use the term “self-management” to describe the many ways that a patient provides self-care for general health or chronic conditions such as diabetes, atherosclerosis, heart failure or high blood pressure.
At the heart of this new approach is a renewed respect for patient autonomy or independence. The patient always has a choice to do those activities that best help achieve their goals. But to make informed choices, health-care providers, including physicians, have to act in collaboration with individuals, providing relevant information about their medical conditions and support to make positive changes in their lives.
Though doctors may be up to date about the evidence-based management of medical conditions, patients know their lives better and every individual has unique personal goals and their own ways of finding meaning in their lives.
Through B.C.’s Practice Support Program, family physicians have been learning new approaches to support patients in the self-management of their own health – what I call facilitating positive change.
One key is that the choice of goal should be the individual’s. The doctor may ask, “Is there anything you would like to change in your life in the next two weeks – a specific goal you would like to achieve?”
If the patient cannot come up with one out of the blue, the doctor may offer some suggestions based on their personal health status. What may be offered is a menu of choices, perhaps involving eating, physical activity, stress management, smoking cessation, sleep or medication.
One useful tool is the acronym SMART. It reminds the physician of the essential elements of goal setting: specific, measurable, achievable, relevant and timed.
By specific, we mean what exactly does the patient want to do?
If the big goal is to become more physically active, what specific activity will the individual begin? When would it be done? How often? Where? With whom? An example could be walking for 15 minutes during lunch breaks with a co-worker on Mondays and Fridays around the park close to the office.
In addition to the specifics and measurables, the goal must be achievable or doable for the individual. To jump from doing no exercise to training for the Sun Run may be too great a leap.
I have found that individuals who have begun personal goal-setting in this way soon become confident in setting progressive goals for themselves. They have been empowered to make positive changes in their own lives. That is the spirit of self-management.
Dr. Davidicus Wong is a family physician at PrimeCare Medical. His Healthwise column appears regularly in this paper. Read more about achieving your positive potential at davidicuswong.wordpress.com.
