Some of the most frustrating things that doctors encounter in their work are preventable diseases caused at least in part by behavior. I am talking about things like type II diabetes or insulin resistance because of obesity, emphysema or other lung conditions because of smoking, liver cirrhosis because of excessive drinking, etc. While doctors are charged with treating these conditions, many of us have no idea how to get patients to change the behavior that led to the diseases. What patients like this need is what Daniel Coyle, in his book “The Talent Code”, calls “ignition”. Let me give you an example of how this works.
My daughter just started piano lessons. After the initial novelty of the first few days wore off I encountered the reluctance to practice familiar to virtually any parent I know. She will sit in my lap with a 5-minute attention span, and that’s about all we can do. At least it was, until her teacher suggested that the end of the lesson be reserved for playing songs and singing along, younger sisters invited. Now, I had actually been about to fire this teacher. He’s super nice and very sincere but seemed not to know much about children or teaching them. I stand corrected. The last lesson ended with him at the piano, kids gathered around, laughing and singing along to the teacher’s improvisations on “Twinkle” and “I’m a little teapot”. The next evening I came home late from work and didn’t have time to practice with my daughter. She started whining. Because we couldn’t practice that day. I had to promise her that we would do it first thing the next morning, and she held me to that promise. What was different? The teacher’s little ignition switch. Look how he can play my favorite songs! I would like to know how to do that! Look how much fun everyone is having! She’ll probably need plenty of other ignition events along the way, but for now she’s excited and motivated.
And that’s what doctors and nurses have to be able to do. Find an ignition switch that motivates our patients. Such a switch is different for each patient, just as a musical ignition switch is different for each budding pianist. Finding it takes time and a well-established relationship with the patient, neither of which are in copious supply in today’s medical system. My daughter’s piano teacher had learned enough about her to know that she loved to sing and knew most of the cannon of childhood songs familiar to American kids. He used those pieces of information as tools of encouragement and motivation. The overweight woman who is about to need medication for her insulin resistance needs to be known and understood by the doctor, in order for the doctor to devise an appropriate ignition switch for her. Perhaps he knows she has a young child whom she would like to see grow up. Maybe she wants to reconnect with an old college friend who is a runner. Maybe she saw her own mother or father succumb to diabetes-related complications. What if she told the doctor that she loves old movies? Could the doctor suggest she get on a treadmill while watching Fred Astair and Ginger Rogers? Of course. This ignition switch wouldn’t work for the next patient, perhaps, but the next patient will have another set of values that can be used to encourage progress. In order for we doctors to do this sort of work we must know our patients and care about what goes on when they’re not sitting in our offices. Like my kid’s piano teacher.