Why do some patients take notes and follow every word you say, while others never do anything remotely close to what you ask? We know that patients improve more quickly and stay better longer when they participate in their home exercise program, so what do we do?
It starts with Motivational Interviewing and removing the word “compliance” from our vocabulary. When a patient does not do what we ask of them, they are labeled as, “non-compliant”. We could just as easily label ourselves as, “non-effective”. Of course, we will never reach everyone, but what if there was a way to improve our effectiveness and place the initial burden of change on ourselves as health care professionals?
My first suggestion would be to remove the word compliance from your lexicon and begin to only use the word, “alliance”. When I was a kid, I cleaned my room, not because I wanted to, but because I was in trouble if I did not. If my parents went away, the cleaning stopped until right before they got home and then there was a frantic cleaning spree to catch up. Sound familiar to anyone else? I was being compliant, but I was not invested in the process. I did not see the benefits of the finished product.
On the other hand, imagine a young boy volunteering in a park clean-up program. He is making the park a better place for all those who use it. He cleans alongside his peers, taking pride in what they are doing. He will probably even tell his classmates and friends in school about the excitement he felt while making the park a better place.
What’s the difference? In the second scenario, the boy has a vested interest. He understands the positive outcome and how everyone will benefit from what he is doing. In the first scenario, he is only cleaning his room because he has been commanded.
So how do we change our patients from showing compliance to alliance? We need to change the way we go about interacting with them and begin to understand what motivates them and understand why they make the decisions that they do. No patient is going to respond the same and therefore we need to find what that specific patient cares about. What drives your patient and where can we bring a parallel to our goals with theirs? It involves asking questions!
There are a number of resources to learn more about Motivational Interviewing. You can start here:
It takes patience and practice, but the time you spend will pay off.