I started my day with a grump. Have you ever had a patient come in, arms crossed and mad as can be that anyone would say he had diabetes? I had an inkling that I might have a challenging patient when he was yelling at his wife before he even got into the education room!
When he and his wife came in, they both plopped down on the chairs and exclaimed, “He does not have diabetes!” He wasn’t sure if the test was wrong, or just the fact that the criteria for diagnosis was wrong, be HE DID NOT HAVE DIABETES!
I generally enjoy my work and my patients, but occasionally, one just gets under my skin. I try to stay pleasant, but it is a challenge indeed. I looked at this couple, angry and upset, and I tried to figure out what I might say that would help them through denial and frustration. Starting with dietary restriction did not seem like a good beginning.
So I went back to my basic knowledge of stages of behavior change.
Wikipedia defines precontemplation as "people are not intending to take action in the foreseeable future, usually measured as the next 6 months." That sure seemed to fit. So I thought, perhaps I’ll just see if I can help him relax. So we chatted about frustrations with medicine, the ever changing world, and basically, I just listened. We started to laugh about life, and I can’t even remember what we laughed about. His wife started to say she liked this visit. The patient asked me if I would like to check his blood sugar (we hadn’t even brought that up!). He asked for his blood pressure to be checked. We talked of healthy eating and laughed some more about how challenging food plans can be. We talked of exercise and how much he thought he was already doing (it appeared to be minimal tasks of daily living…but that will wait for another day). When he left the office, he agreed to keep track of his food, watch the quantity a bit, and keep moving. In addition, he is willing to return next week.
So, back to behavior change. Perhaps he has shifted categories: Preparation is "people are intending to take action in the immediate future, usually measured as the next month” in Wikipedia. Now wouldn’t that be great!
Share your stories about challenging patients, and how much “patience” it sometimes takes just to make them smile and return, no longer as angry and perhaps even ready to make a change or two.