Editor’s note: all clinical examples are sourced by Dr. Alison Chen, ND
TODAY’S ARTICLE IS ABOUT MOTIVATION, but not the rah rah motivation telling people “you can do it”. That motivates the already motivated; this article is about getting the people teetering on the edge of unhealthy relapse to stay with it.
50% of a Naturopathic doctor’s job is to get the patient into the clinic and give them enough encouragement to stay. The supplementation, lifestyle changes, and nutrition protocols is the other 50%. Admittedly, I don’t overwhelm my new patients in the initial months of developing our plan. My main focus is always to get them to both feeling comfortable with basic foundational changes to their lifestyle and feeling better.
This article is not about being a cheerleader. It’s about understanding motivation and what kind of feedback to give and when. Rewards are sometimes effective and sometimes detrimental to long-term adherence; I’ll explain when and how to use them.
At the end of this article, I’ll outline a couple systems you can implement in your own business. As always, look past the specific example and understand why my system works.
The best practitioners educate and empower. Ownership over a decision leads to adherence. A client needs to feel as if they had a say in the design of their health protocol.
You lead the way and guide them towards a decision, but let them make it. New patients have often been inundated with information before they come into the office. They know the basics. For example, the amount of times a new patient has told me that work is their main source of stress and they don’t exercise enough always surprises me, but it happens often.
When it comes to nutrition, patients often know the 20% that will get them 80% of the results; they just don’t know that they know it. So, like most NDs, I get them to track for at least 3 days what they ate and present the sheet to me. I then:
- Look over the sheets.
- Spread them on the table where we can both see them at the same time.
- Ask him to circle whatever habits he or she wants to change.
- I then tell him to rank what he considered to be the most important habit that needs changing to least important.
Without fail they picked what I would have picked, except THEY PICKED IT. I then look at them, smile, and said I agree. Their goal for the coming week was to fix that one habit; once they did, we would move onto the habit they chose as #2.
Always ask yourself: are you giving your patients what you want to give them, or what they need?
“Are you giving your patients what you want to give them, or what they need?” – Click to Tweet
The Reward is the Task (sometimes)
Naturopathic doctors can be too focused on providing extrinsic motivators for performance. Perhaps it’s easier; that, or maybe we were brought up with extrinsic rewards and have never considered that they could be potentially harmful to motivation.
An extrinsic reward (for example saying “that’s great” for every supplement their patient remembers to take) changes the client’s purpose for completing the task.
A neuroscientist named Brian Knutson showed, using functional magnetic resonance imagery (fMRI), a burst of dopamine would rush into the brain when the participants anticipated that they were about to receive a reward. Physiologically the response to getting an award is akin to an addiction. The only way to maintain the desired response to the reward is to continue and give bigger and bigger rewards.
In order to get long-term results your patients needs to be intrinsically motivated. According to Daniel Pink in Drive, there are 3 pieces of the puzzle.
- The first is autonomy, which I covered above.
- The second is mastery. A main aspect in the path towards mastery is achieving flow. According to Mihaly Csikszentmihalyi the challenge cannot be too easy, or too difficult. It must stretch the body and mind in a way that makes the effort itself the reward.
- The third is purpose. Purpose is the patient’s emotional reason behind their health goals. If losing 10lbs means that your client feels he will be able to be around longer for his children — that’s his purpose. Make sure your clients are aware of the purpose behind their protocol, and not the superficial goals.
I’ll finish this discussion off with a beautiful poem by W.H. Auden.
You need not see what someone is doing
To know if it is his vocation,
You have only to watch his eyes:
A cook mixing a sauce, a surgeon
Making a primary incision,
A clerk completing a bill of lading,
Wear the same rapt expression, forgetting
themselves in a function.
How beautiful it is,
That eye-on-the-object look.