Why doesn’t Mrs Smith help herself?

Going into the amputee rehabilitation centre today I saw a number of people – minus various limbs - sitting around outside in wheelchairs smoking. 

This is not unusual I have to say.  I am not a fan of smoking but it always strikes me as sad that people who have lost limbs due to compromised blood circulation aren’t motivated enough to eliminate smoking from their diet.  But when you think about, I am passing judgement from my viewpoint and I don’t have a clue how these individuals see the world.

Now I don’t wish to debate the rights and wrongs of smoking here.  I wouldn’t like to think that we start passing judgement on others too quickly in order to control them.  There is a great tendency anyway for more and more control applied to each of us for the collective good.  I don’t really want to debate that here.  I am interested in the attitudes and beliefs of people that lead to behaviours and consequences.

One of the challenges we face in the UK at least is that medical science allows many more people today to survive the consequences of, for example, peripheral vascular disease for longer.  This is surely a good thing. 

Once upon a time a person may have had a leg amputation and even after rehabilitation with a prosthesis or a wheelchair we would realise that prospects of survival would be limited.  Today however, we have leg amputees who are surviving longer – going on to have other higher-level amputations of the leg as well as having increased likelihood of arm amputations.  When blood flow is compromised it sadly affects all of the circulatory system.  Whilst prostheses and rehabilitation are improving it is always going to be a case of “shutting the stable door after the horse has bolted.”  Prevention is what matters and one aspect of shaping that is to consider human behaviour and attitude.

What I did have the opportunity to do recently was discuss with a group of clinicians the motivation strategies that could be used with their patients.

Imagine you are a doctor - Did you ever have the feeling that you made strong recommendations to your patient, used your best possible words to “persuade” someone – and thought that he or she really got the point – only to find that your patient did not do what you recommended?  Probably a special strategy might help.

Sometimes it is very useful to find out how people are motivated.  Fundamentally, one way of thinking about this is that we all are moving towards pleasure or away from pain.  Put another way, we are

“Moving towards something“ kinds of people or “Moving away from something” kinds of people

My view – and just look around you to check what you think– is that there are many more moving away from pain kinds of people than moving towards people.   People mean to do things, say they will do things … and yet they wait and wait and wait.

There are those people who respond much more readily to running away from a threat than approaching an aim.  There are people that like to have a blank, clutter free, desk and others who simply don’t want to sink into total chaos as paper cascades from heaps piled all over the desk.

There are people who fill in their tax-forms to feel good that they have dealt with all of that in lots of time – and others who only respond at the very last moment when they realise that the pain felt by not dealing with this is now greater than the perceived pleasure that would come from doing something else.

There are people, who do sports to stay in good health – and others who do so because they would like to lose weight or have some other complaint go away.

And .. there are those who invest in pension plans to have a good time during retirement and others who are afraid of being poor and old.

So lets have a look at Mrs Smith. 

She is an “away from something” patient.  When you want to attract her with positive benefits such as “better mobility” or “improved cosmesis” it simply won’t work as well as if you came up with a different strategy that’s meaningful in her world.  For her, the new prosthesis will seem like gold if she knew that this prosthesis would help her avoid some dire consequence – like losing her other leg.  And remember that what would be a bad outcome for one person would be of no consequence to another.  It’s the individual’s perception that matters.  We have to be careful here about the ethics of scaring people I guess.

Mr Jones, who is by contrast a “towards something patient” would not be motivated by the same things as Mrs Smith.  He would be much more interested in the fact that if he had this prosthesis he would be able to join his daughter at her wedding next month or that this would keep him independent for so much longer.

For all clinicians, if you know how someone is motivated, life gets much easier.  You can avoid having to struggle with people to “get your own” way against the will of someone who simply does not and never will, see the world the way you do.  Compliance to treatment will grow once you meet the person in his or her own world rather than broadcast from the lofty position of your own.

And you know what, when you really think about this, it works not just with patients.  It works with doctors, therapists, assistants - and in the world outside. This even works with your children.

How do you find out if they are away from or towards something people?  Well, I suggest you don’t interrogate but instead use metaphor (story telling) or just get to know them by asking innocently about situations and see how they respond.  By looking for contrast we can easily see what works.

Why not start with yourself. Go back to a time in your life when you were really strongly motivated to do something and you actually took action.  Remember what it felt like? What did you see, what did you hear, what did you feel? 

Now just for contrast think of another situation where you just knew that something needed to be done – but you just procrastinated – you waited and waited until the pain of further delay just overcame your resistance to react.  Note again what you saw, what you heard and what you felt.  Notice that how we represent these situations in our physiology is completely different.  For now, all I can tell you is that with patients it gets much much easier if you are working with representations that motivate them rather than ones that lead to procrastination.