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October, 2010

From Understanding to Influence: Getting Inside a Patient's Head

By Shelley Simon, RN, DC, MPH, EdD

We often imagine that our jobs would be easier and our practices more successful if only we knew what our patients were thinking. What's the real reason underlying their resistance to committing to a full course of care? Why don't patients follow simple advice about exercise, nutrition and other lifestyle modifications that would so obviously benefit them? If patients are so pleased with the outcomes they experience, why don't more of them refer their friends? If only you were a mind reader, you'd have answers to all of these questions and the leverage to influence patients.

Alas, mental telepathy is not taught in chiropractic school, and intuition is rarely 100 percent accurate. In addition, your impressions may be based on your own projections, desires or fears, rather than on what patients are actually thinking. If you want to get inside a patient's head, the best approach is to do so for the right reasons and use exemplary communication and interpersonal skills.

You have a valuable service to offer and it's perfectly legitimate to want to better understand patients in order to move them toward agreement; to get them to "yes." Your objective in understanding the beliefs, biases, fears, goals, motivation and resistance of any patient should be to positively influence them to actively participate in a level of care that works for and inspires them. If, instead, you are seeking to understand patients to persuade them to get on board with your agenda, you may find yourself frustrated and unsuccessful in your efforts.

Influencing vs. Persuading

The words persuasion and influence are often used interchangeably in casual conversation, but there are important distinctions to be made. Persuasion aims to convince someone to take action, typically before groundwork has been laid to have earned the individual's trust, buy-in or commitment. We persuade when we make a case or present information in an effort to sway another's opinion or make them see things our way. There are several potential problems with using persuasion. First, it can be perceived as manipulative. Second, commitments made based on persuasion are often half-hearted and temporary. Third, when persuasion is used routinely (especially with a side order of charisma, charm or fear tactics), it often results in doubt, discomfort and distrust on the part of the targeted individual. Finally, patients who have been persuaded may experience buyer's remorse and fail to follow through with their commitment, even if what they "bought" is a high-quality service they actually need.

Influence, as it relates to care, involves working with a patient to create a shared vision for a positive health outcome, and then motivating the individual to become engaged in making their vision a reality, without using force or coercion. When seeking to influence, you must educate and offer advice based on your expertise, while concurrently developing a collaborative relationship based on the individual's preferences, needs and desired outcomes. Keep in mind that you earn credibility by showing respect for where the patient is and what they're ready for at each juncture of care. This is a very different process than delivering a report of findings and using the force of your personality to get a patient to agree to what you want them to do.

The first step in positively influencing a patient is to better understand what they are thinking and feeling. This requires adopting certain attitudes (ways of being) as well as practicing key skills (methods of doing). Let's look at these two categories one at a time.

Being

Chiropractors who seek to understand patients in order to positively influence them embody and display empathy, curiosity and respect. The ability to demonstrate empathy toward patients requires actually feeling empathetic. This is not always easy when you're listening to a recitation of low back pain symptoms for the fifth time in an afternoon. To you, back pain may be the tip of the symptomatic iceberg, something to be managed on the way to neurological integrity or stabilization of spinal mechanics. For the patient, the experience of pain is a big deal. It's unique to them and has both physical and emotional ramifications. Try to put yourself in your patients' shoes by recalling a time when you were in pain, worried about a health issue, or upset because your body was not functioning optimally. Do this, and you'll likely experience and exhibit greater empathy.

Curiosity requires staying fully present. As a patient describes their pain or what led up to the situation that's causing them trouble, listen for clues about what might be indirectly impacting their symptoms, choices, or behaviors. Genuine curiosity leads to better questions, the answers to which may guide you to the most accurate diagnosis, most effective care plan and best clinical outcomes.

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