One of the buzzwords in the medical profession is something called "patient activation." That's the challenge of enlisting regular people in health maintenance. To state it more plainly, it's all about trying to get people interested in saving their own lives.
Which seems like it should be pretty easy, doesn't it? We save our own lives in simple, immediate ways all the time. We avoid walking into traffic, because we don't want to die from getting hit by a car. We don't stick knives into activated toasters (electrocution), and we wear personal flotation devices when we head out on a fishing trip (to avoid death by drowning).
But in other, equally important ways, many people don't save their own lives. A little more than a decade ago, a Canadian-led research effort, known as the Interheart study, established that 90 per cent of the risk from cardiovascular disease comes from nine lifestyle choices.
Most of them are pretty easy. We're talking things like, don't smoke. Exercise -- definitely. Manage stress. Limit your alcohol intake. Eat reasonable amounts of unprocessed foods -- for sure.
And yet, heart disease remains the world's leading cause of death. And most doctors are accustomed to seeing patients who just don't take care of themselves. Who nod when we suggest they make key lifestyle changes, and then return the following year in the same shape.
How to get these patients to save their own lives?
That's the challenge of patient activation -- the so-called "blockbuster drug of the century."
Part of the reason it's so hard to activate patients is the current makeup of the conventional health-care industry, which focuses on empowering doctors and hospitals to heal sick patients, rather than empowering regular people to keep themselves fit with a few healthy lifestyles.
Transforming the average patient into the activated patient is the topic of a presentation I made recently at the annual meeting for Johns Hopkins Medicine's international partners, in Baltimore. As research for the talk, I dug into the client survey data that we gather at Medcan, the wellness clinic where I work. The numbers were encouraging. For example, 86 per cent of our clients agreed that they exercised to keep themselves healthy and feeling good. The same proportion watch what they eat in order to stay healthy. And 94 per cent indicated that they believe their behaviour affects their health.
This is great news because much of the research indicates that patient activation forms a continuum. According to the University of Oregon's Judith H. Hibbard, who has written widely on patient activation, "patients progress through four stages as they become activated." First, they become convinced that they can do something about their health. The second stage sees them developing the learning and confidence to "act on their own behalf." Third? "They actually act," says Hibbard. And the fourth stage in the continuum sees patient confident and educated enough that they can advocate for themselves "even under stress."
Hibbard's research suggests that to become activated patients, who work with their health care providers to improve their wellness, many people need only a nudge. By distilling the research in behavioural modification techniques, I've put together a step-by-step approach that attempts to form that nudge.
It's designed to motivate people to save their own lives. To become activated patients. I've used it myself with some of my own clients -- and it works.
Step One: Find a reason to pursue a long and active life. It could be nearly anything--so long as it's specific. Some of my middle-aged patients who are parents make it something about their children or grandchildren. "I want to live a long and active life because... I want to be able to dance at my granddaughter's wedding." Or: "I want to be able to teach my son how to wakeboard." If you don't have kids, you could tie the statement to a career objective, or travel goals.
Step Two: Behavioural change is all about rituals. So the next step involves linking the purpose you established in step one with a ritual that will help you achieve it. Make sure the ritual you set is practical. Maybe your doctor's warned you that your blood sugar levels are high enough to push you into insulin resistance, the precursor to type 2 diabetes. And let's say the key time that sees you reach for sugary snacks is a low-energy period you get around 3 p.m. Perhaps your new, life-extending ritual could involve a mid-afternoon walk around the block as soon as you get that craving.
Step Three: Build some sort of accountability that rewards you for maintaining your ritual--or discourages you from breaking it. This could be as simple as a regular conversation with a friend who you've asked to check in on the maintenance of your habit. It could be a visit to a doctor to determine that your blood glucose levels are dropping. Or it could be more involved--the hiring of a coach who checks in to make sure you're sticking with your goal, or the purchase of a Fitbit that assists you in getting the activity that you require.
Putting all three steps together, the activation process involves something like this:
1. Purpose: "I want to be able to dance at my granddaughter's wedding..."
2. Ritual: "...so I'm quitting jujubes and going for a walk when I feel cravings..."
3. Accountability / Reward: "...and when I've gone for 20 walks in a month I'll indulge in a new pair of walking shoes."
Easy, right? Perhaps you can use a similar method to improve one of your own key health behaviours. It doesn't really matter what you do. What's more important is that you become a participant in the maintenance of your own health. If patient activation is the next century's blockbuster drug, then you've already started your prescription.
Dr. James Aw is the chief medical officer at Medcan, a wellness clinic in Toronto.
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