Counseling Patients: How Can We Help Patients Follow Our Advice?

Introduction

• Patient education and counseling have been proven to contribute to behavior change

• I wanted to improve my counseling skills

• I had my attending observe me counsel a patient on dietary changes and immediately give me feedback

• I then read about affective ways to counsel patients

• After educating myself, I had my attending observe me counsel another patient on dietary changes and immediately give me feedback

Things to Keep in Mind when Counseling Patients

Phases of change

• Precontemplation – These patients are picked up during routine visits

• Contemplation – Often have ambivalent feelings about change, but are open to suggestions

• Determination – Willing to take action and need help deciding on the best strategy

• Action - Patients continue to require support during this phase

• Maintenance – Patients continue to need evaluation during this phase

• Relapse – Physicians and patients need to remember that relapse is expected. Patients need help to avoid becoming demoralized and gaining the confidence to reinitiate action

Things to Do

Initial Assessment

• Asses patient’s knowledge

• Explore patient’s beliefs

• Assess patient’s motivation

• Asses impediments to change

Counseling

• Use multiple forms of counseling: talking, informational pamphlets, outside resources

• Offer multiple options

• Ask the patient to involve their friends

• Advise the patient about pitfalls

• Before leaving the office, as the patient to repeat the plan

Continued Support

• Help set the patient up with assistance (i.e. AA, smoking cessation classes)

• Reward the patient on their progress

• Ask the patient how they feel about the change

Things Not to Do

• Don’t use medical jargon when counseling patients

• Don’t argue with a patient’s misconceptions, simply inform them of the medical knowledge

• Don’t assume the patient has not relapsed when following up

• Don’t forget to chart the counseling provided and the stage of change the patient is at

Conclusion: How I did

• My initial encounter seemed disorganized. I did not first assess what issues the patient may have in maintaining a healthy diet. Instead, I started giving the patient advice and later realized that he is a trucker and it is difficult for him to avoid fast foods. I offered the patient multiple options. The attending thought I did a good job in offering multiple options and listening to the patient. However, she did not feel that I established with him something to work on and begin change.

• My second encounter I was more prepared. I gathered the clinic’s written materials on diet beforehand. I made sure to assess the patient’s knowledge of diet and health first. From there, I was able to provide the patient with the accurate medical knowledge. I assessed the patient’s impediments to change. I then gave the patient several methods of improving his diet and discussed how he felt about these changes. This enabled more discourse on the topic and on potential pitfalls. I was able to give the patient reassurance that I believed that he would be able to make some small changes. I then asked the patient to go over a plan with me and concluded by giving him the pamphlets. The attending thought I was better prepared this time. She thought the patient connected with me and was more willing to listen to my ideas for changes. She thought the patient was more likely to institute some small changes.

References:

Mullen PD, Simons-Morton DG, et al. A meta-analysis of trials evaluating patient education and counseling for three groups of preventive health behaviors. Patient Education and Counseling. 1997 Nov;32(3):157-73.

Basler HD. Patient education with reference to the process of behavioral change. Patient Education and Counseling. 1995 Sep:93-98.

May S, West R, Hajek P, et al. Randomized controlled trial of a social support (‘buddy’) intervention for smoking cessation. Patient Education and Counseling. 2006 64; 235–241.

Kreuter MW, Chheda SG, Bull FC. How Does Physician Advice Influence Patient Behavior? Evidence for a Priming Effect . Archives of Family Medicine. 2000;9:426-433.

Marcus BH, Goldstein MG, et al. Training physicians to conduct physical activity counseling. Preventive Medicine 1997 May-Jun;26(3):382-8.

Nett LM. The physician's role in smoking cessation. A present and future agenda. Chest. 1990 Feb;97(2 Suppl):28S-32S.

Category: