I’ve been ruffling feathers over here while speaking at AIMA in Auckland. While I am pretty familiar and comfortable with that role (& responsibility?) – this topic ruffled my own, arguably the most. In fact, I kicked off the presentation with, ‘What I’m going to say might make some of you uncomfortable but you know what, it makes me uncomfortable and if it makes you think a little less of me, well, to be honest, contemplating these issues has already made me think less of me!”
As an educator in integrative health, I have overwhelmingly been a peddler of knowledge and skills under the headings of:
‘WHY’ and ‘WHAT’
Why – as in why does this patient present in this way, at this time. I am passionate about upskilling practitioners re our powerful contribution to the diagnostics & work-up of each individual. What – as in what changes (supps, herbs, diet etc) need to happen to correct for these very unique elements of imbalance in this patient to therefore aid resolution. We might label this, ‘personalised medicine’. But after so long in practice it’s patent that the best results don’t come from being the cleverest clinician nor the biggest biochemical brainiac. Knowing the ‘why’ and even the ‘what’, while enough for a minority of patients, fall short for the rest and can still fail to be truly about, & exclusively with, the most important person, in mind.
We’ve learned this before but it needs to be said again and again and again: much of any medicine is via the therapeutic relationship – and as part of this, our ability to PLACE the patient at the centre of their own SOLUTION.
And therein lies the conversation we need to have in detail with them about the ‘HOW’
But how much time in your current consults is afforded to the ‘HOW’?
Being able to effectively negotiate with out patients the ‘HOW’ is an extension of Motivational Interviewing, Behaviour Change Theory & Patient Centred Care. It returns the humanity to our list of recommendations for each patient, pushing back against the autocracy that can tend to slip in with prescription writing. It powerfully reminds us that the prescription is only ever as good as the patient’s engagement & buy-in, and that’s only ever as good as our ability to write a prescription that is accessible & readily transplantable into their existing lives: to co-create with them Patient Centred Prescriptions. Someone in the audience had been my patient in the past – double awks right – because I absolutely know, I didn’t know this well enough back then. Back then when they were unable to do exactly as I had recommended – with their diet, their supps, their sleep, their work-life balance – they had, in turn, apologised for their ‘weakness’, ‘lack of willpower or diligence’ and me, being ever so gracious, accepted those apologies only to repeat the error of my ways and write yet more scripts that set them up to fail. 🤦♀️ I am committed to getting better at this and in this endeavour, giving both more attention & time in my appointments to the ‘HOW’ & yes I think we need to think creatively about how we use our appt time and between session touch points to achieve this – keen to hear about your perspective and experiences.
Compliance Changers – Strategies for Success
At the end of an information & insight heavy appointment, formulating a list of products and doses for our patients to take can feel like a bit of a ‘tada moment’, like a magician pulling a rabbit out of the hat. “Here is the solution – now off you go!” Research tells us, however, that treatment-plans that are a co-creation between you and your patient – evolving from a discussion that not only allows them a voice, but a major role in the decision making – are far more likely to succeed. While we are the authority on our medicines, our patients are the authority on what makes them tick & what’s likely to succeed, in terms of taste, texture, temperature & timing! This is called Patient Centred Prescribing and together with some other tips tricks and hacks I share with you in this episode, can really increase patient buy-in, compliance and therefore bring your treatment plan to fruition and fulfilment!