According to the radio news on Tuesday, all front-line health professionals in the UK are soon to be required to use every patient contact to dispense advice on healthy living. Whether concerning weight loss, exercise or alcohol consumption, every opportunity will be taken to promote a ‘healthy-living’ agenda.
I was struck by the opposing positions taken by the two guest speaker on Radio 4’s Today programme (Tuesday 10 January). One argued that this was the nanny state pushing messages that research shows will largely be ignored by the public, while the other felt strongly that it was the duty of the doctor to give patients such messages, and that it would result in behaviour change.
In my view neither position quite captures what will determine the success or failure of the initiative. Essential to the success of the project will be a) the attitude in which the advice is given and b) the precise approach taken, at the level of the relationship and the communication between the health professional and patient. Let me explain:
Attitude: How many of us like to be told to change some aspect of our behaviour? Of course we don’t. We have well-worn defence mechanisms that we quickly put up – even when we know at some level that the other person is right. Anyone wishing to change another’s behaviour must, most importantly and paradoxically, recognise that YOU CANNOT change another person! You can only create conditions in which they may decide to do something differently. In fact the more wedded you are to the rightness of your view and to them changing, the less likely you are to have the effect you want! (Unless you happen to be a bully or otherwise rule through fear!)
Approach: ‘telling’ or ‘advising’ without first being asked for help, tends to generate a negative or resistant response in the other party, even if it is masked by politeness and the appearance of agreement. Far more effective is to first get the other person to start thinking about their own interests, for which the best technique is to ASK. Not a closed question that will generate a judgement by the other person (I agree / disagree), but an open question that invites new thought in the other person’s mind. So in the case of the health professionals, they might for instance ask: “What could be the be benefits to you of stopping smoking?” And then of course comes the very hardest part of all: the need to wait, sit through a potentially uncomfortable silence, hold fire with all advice, LISTEN and wait some more while the patient starts to think for themselves in new and productive ways about how they might start to change.