Behaviour change is hard wired to be difficult. I expected a patient who came to me with low back pain to exercise when she’d never exercised before. Here is how my patient taught me the importance of eliciting her ‘why’.
As physiotherapists and I’m sure, many other health practitioners, we tell people what to do and how to do it. But often we don’t consider why the person might want to take our advice.
Often patients who are assumed to be ‘difficult’ have never connected with why they might choose exercises or other advice over what they currently do.
To embrace advice given to them from health professionals, they will have to change what they currently do. They will have to cut something out of their schedule to fit in this new ‘thing’. This new ‘thing’ might be exercises, treatment, diet, or a new habit. Whatever it is, conscious processing is required. As is a plan and willingness to make the changes needed to help them change their lives.
Whether you realise it or not, when managing patients you are asking for behaviour change.
What is the primary driver for behaviour change?
Behaviour change requires mental, emotional and physical effort of varying degrees. The other person has to want to make this effort.
The primary motivation that drives any of us to do something different are feelings linked to our core values.
We know from evidence that even those facing death may not change their behaviour with regards to exercising, eating, smoking and other behaviours that impact health.
Patients can say they want to get rid of pain. But pain relief in chronic conditions is a poor motivator for doing exercise programs or coming in for treatment. Acute, severe pain can certainly drive behaviour change in the short term.
Here’s how my patient taught me the importance of eliciting her ‘why’
I had being seeing a 59 year old lady with chronic back pain for over 2 years. She would come in and say she wanted to get rid of her back pain and asked for exercises she could do at home.
On follow up she rarely, if ever did the exercises and always had excuses as to why she hadn’t done them.
One day she came in and asked to join an outdoor exercise program that I was running. It required a 10-week commitment of 2x/week for 90’ and also a financial outlay that was non refundable.
I was extremely surprised by the request as she had never committed to any exercise in the past even when she had initiated the request.
On further discussion, she then told me she wanted to walk the Kokoda Track when she would turn 60. This would have made her the first 60-yr old female to have completed the track.
As I listened to her I realised that what was driving her commitment to do the exercise program was pride, a sense of achievement and self satisfaction.
This was her ‘WHY’. It had nothing to do with getting rid of back pain, getting fit or losing weight. Her ‘why’ was related to the feelings she would get when achieved her goal.
As she struggled in the early stages of the program I would walk next to her and talk to her about how she would feel when she stood at the end of the track. As I did this she found her own motivation to continue.
She struggled but ultimately completed 20 weeks and was the first 60 year old to complete the track. After doing the program she had lost weight, got fitter and developed a habit of exercising. She also had much less back pain.
What lesson did this lady teach me?
I was focused on what she could do to manage her back pain rather than finding out what she missed because of the back pain and why this was important to her.
If she had never found her own reason for exercising, I certainly didn’t have the tools 15 years ago to help her. Both of us would have ended up being frustrated!
If I was still managing patients and saw someone like this now, I would want to know what did the back pain prevent them from doing and WHY was getting this back important to them.
When patients say they want to get fitter, get rid of pain, get back to sport etc, these are all OUTCOMES. They are not the patient’s WHY.
This lady taught me that what has been lost because of the situation she found herself in and why that was important to her had more impact in changing behaviour than logic.
Put another way, it’s important to find out what will be the positive outcomes of following advice and why that is important to the individual?
Once you get this information then you can frame your exercise/rehab program in a way that resonates with the patient’s why.
A person’s ‘why’ will always have an emotional component to it. Perhaps this is the reason it’s hard to elicit. Working with emotions is not something physiotherapists are used to dealing with.
For those not comfortable asking questions to elicit emotions, listen with full attention to what the person is telling you. During the consult you may get an incite to the emotions they are missing and want to regain. When this happens, dig a little deeper.
Simon Sinek’s “Start With Why” is directed to business owners but he has a very important lesson for health clinician. They often spend a lot of time telling patients what to do and how to do it. Rarely does the clinician take the time to find out why their patient might want to do what’s been asked of them.
For those new to eliciting a patient’s why, here is a suggestion you can use.
Ask the patient:
“Imagine you have achieved (insert their goal), what would be the positive outcomes?”
Listen to the answers and follow up with:
“Why are (insert outcome/s) important to you?”
These questions allow the patient to consider a future with the outcome they want and then to relate it to values that are important to them.
For more information on questions to elicit motivation read Case Study #2
Sometimes your patient can be your greatest teacher as many of mine were. When things are not going as you’d like them to, it’s time to reflect and see if there is a better way of doing things.
In this scenario, my patient taught me the importance of eliciting her ‘why’. For that lesson I am grateful. It helped me better manage patients who seemed to be stuck in old beliefs and behaviours.
I hope that this lesson helps you to shift just one patient who is not committing to what needs to be done in order to achieve the treatment outcomes they want.
To learn more about motivational tools through effective communication download my eBook:
I wrote this eBook in response to the most common question I get asked and that is “How do I motivate my patients?”
Or perhaps your staff would benefit from training in this area.
Contact us, and find out more about what we can offer you.
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