Y’know, it is all about the approach. Consider Vicki’s recent blog about how in some parts of the world community pharmacists are putting the profession out in front of their businesses, both figuratively and literally.These pharmacists have chosen a different path. Thanks, Vicki, for reminding me about something that we are supposed to use with our patients when their choices and behaviours aren’t the best ones for their well-being.The same process applies to both patients and pharmacists contemplating their future choices and behaviours as health professionals.And so, as a free service, I will share with you some of the things I have learned about helping patients with choices over the years, and about change.(For those of you who believe that we pharmacists give too much away, and should charge for all we do, please feel free to send money).Some of you may recognize the following from health coaching interventions and techniques, including motivational interviewing and communication and sales skills and principles.This may take a few blogs (first rule: don’t overload the patient).Assess behaviour and choicesThe first step in working with a patient (or pharmacist) is determining whether their current behaviour or choice is cause for distress.This may require some education around the problem, such as how what the individual is doing is affecting their future health and happiness.Of course, this knowledge must be important to this individual. Often, determining the person’s priorities, wants, and needs is important at this point.Questions about where they see themselves in the short and long-term, and whether they are happy about their prospects, is a key ingredient to the conversation for those who do not perceive themselves as at risk.This knowledge, however, must be relevant to the patient (or pharmacist) in that they see themselves as someone to whom this risk applies.If they do not believe that the science applies to them, it’s critical that you provide a link, or better yet explore those impacted and have the subjects recognize themselves as being at risk.And yet, even if they see themselves as at risk, they must believe that they can do something it.They also need to believe it is worth doing, they must be confident that they can do it, and they must also recognize that for change to effectively influence outcomes it must be continuous.Finally, the patient must accept that change is an ongoing process of adjusting, adapting, refining, and starting over again.And, importantly, this realization must come from within.The three brainsOften, at this point it important to help the victim understand that, like everyone else, their decision processes are clouded by the conflicts between two of the three brains—the emotional and the logical.(The third, the animal brain, just runs our bowels, and sometimes even has a hard time doing that right).The emotional brain is all about seeking comfort and happiness. It also, most will admit, is behind almost all bad decisions.The logical brain, on the other hand, will have recognized those bad decisions ahead of time. The problem is that inside your head, the emotional brain yells louder and/or refuses to listen to the logical brain.Some methods to equalize the argument are written decision processes, such as going through the pros and cons of behaviours, using this for barrier identification, and written change plans.Other methods include meditation or cognitive behavioural therapy, which attempt to separate the two brains in your head.These approaches accomplish that by allowing the intellectual brain equal time with the emotional brain, as well as by training the emotional brain to listen to, and understand, what the logical brain has to say.Engaging this fair decision process is critical, and there is plenty of science that supports more positive, and less negative, behaviours as a result of doing these things.Communication techniquesOne important intervention for patients (or pharmacists) who are worried, frustrated, or overwhelmed with the way things are going is to use communication techniques.This includes open-ended enquiries, reflection, and empathy to develop the story and the relationship.I will get into the next steps later, but to simplify I offer the following case studies, in parallel, of a patient and a pharmacist contemplating their future.Coach: Hello. My name is .Patient/Pharmacist (P/P): Hi, .Coach: Tell me how I can help you today.P/P: I keep hearing from everyone how if I don’t change the way I do things, I might not be around after a while.Coach: And what do you think of that?P/P: I don’t know. I don’t think things are that bad.Coach: So you are saying you don’t think things are that bad.P/P: Well, they aren’t great, but they could be worse.Coach: So what isn’t great?P/P: I like living my life the way I want to, and I don’t like changing.Coach: I think in that way you are like most people.P/P: Right, so, I mean, what’s the big deal?Coach: What will happen if you keep doing things the same as you are now?P/P: I know in other people’s situations there have been some problems because what they kept doing got them into some trouble, but I don’t think that will happen to me.Coach: So what makes you different?P/P: I…don’t know.Coach: From what you have told me, it sounds like the way you have been doing things may get you into trouble, and that other people have made changes to keep them out of that trouble. What do you think your chances are of escaping the same fate?P/P: Not very good, I guess. After all, doing the same thing and expecting different results is the definition of insanity. (Note: I have had several patients say this exact quote to me, and it is something that, even if they cannot articulate, everyone understands.)Coach: So what different things can you do?P/P: Well, I know things aren’t the way they used to be. And I guess if I am not careful, I won’t be around as long.Coach: And it is possible you may suffer in the process.P/P: You’re right about that.Coach: It sounds like the prospect of not changing doesn’t look too good to you. How can I help you?P/P: I don’t know—you are supposed to be the expert.Coach: I do know about making change, but what I don’t know is what helps you make changes. You are the expert on that.P/P: Oh, I guess you are right.Coach: What kind of changes have you made in your life that have worked out for the better? They don’t have to be about health.P/P: Well, since I moved to this area things have been better.Coach: And what did you do to arrive at the decision?P/P: We had a few places we could go, but when we looked on balance there were more things in favour of coming here, and only a few problems that were easy to fix.Coach: So, what you did is called decisional balance—looking at the pros and cons of a decision, and then using those to make the best decision while using some concerns you found to know what to solve so it wouldn’t become a problem.P/P: I guess you’re right.Coach: What do you think of doing the same thing for your health/the future of your profession?More to come.Ken Burns is a pharmacist at the Diabetes Care Centre at Sudbury Regional Hospital.
