In the old days (or at least until now), doctors would give their orders (i.e. lose 50 lbs; exercise aerobically for 60 minutes, 5 days a week; eat a low-fat, low-salt diet; and take each of your medications as directed).
When you returned a year later – for a refill of your 3-month supply of medications, having lost no weight, not yet started on that exercise program and following the same snack food-supplemented fast food diet, doctors would label you as “noncompliant.”
That is now considered an old (med) school term. To be noncompliant literally meant that the patient didn’t bend to the will of the doctor.
Through my province’s Practice Support Program, I’ve taught my colleagues the new approach to helping our patients achieve their goals in health. We recognize that only a fraction of a patient’s health care is provided by doctors, nurses and other allied health care providers.
The majority of health care is self-care. Patients themselves are responsible for their own health between clinic visits. Our role as physicians is to support them in the self-management of their health.
To facilitate positive change, we have to change the old way doctors set goals with their patients. Recognizing that though physicians may be the experts on medical conditions, it is patients who are the experts on their own lives.
If a patient is “noncompliant” with the goal set by the doctor, it is quite likely that the goal was the doctor’s and not the patient’s.
In our new approach, we recognize that goal setting must be collaborative. Those goals must be those of the individual who must feel that they are both personally important and possible for them to accomplish.
Next: How the new principals of facilitating self-management can help you achieve your own goals.