Understanding Patient Motivation And How It Affects Your Treatment Plan

What motivates patients with diabetes to follow an appropriate dietary plan or offload an acute lower extremity injury? Answering this question can go a long way to getting patients to adhere to your prescribed treatment. The motivation of the patient can be a key factor when it comes to optimal treatment for his or her condition.

Numerous theories of motivation include reinforcement, process or content. These notable theories help to explain what drives people toward certain actions but the theories do not necessarily describe internal and external sources of motivation. Just as teachers are more effective when they are able to recognize individual learning types and appropriate behavior reinforcement, it is essential that healthcare providers are able to identify patients’ sources of motivation, which are extremely varied.  

A combination of both internal and external sources guide motivation. Internal motivation is based on physiological needs, such as the need not to be in pain or the need for security and achievement. It is based purely on autonomy and self-regulated goals and behaviors. External motivators come from sources outside of the individual such as peers, physicians and, in the case of minors, guardian feedback.           

Podiatric physicians play an integral role in the interdisciplinary management of many chronic diseases. At times as podiatrists, it is easy to figure out what motivates a patient. In other instances, it is not as intuitive.

For example, a patient with diabetes may choose to adhere to a strict diet and control the blood sugar levels in order to prevent sequelae such as neuropathy and peripheral vascular disease, which may lead to ulcerations, possibly resulting in loss of limb or life. On the contrary, another patient with diabetes may spend numerous hours at work in destructive environmental conditions, wear constrictive footwear, is unable to have time to prepare healthy meals and may develop an ulcer. The necessity to maintain employment may be at the expense of not being able to heal the wound and in turn, patients may be absent from work for hospitalizations.    

A variety of factors motivate postoperative patients and those with acute injuries. There are usually two extremes: those who are motivated to get better so they can discontinue wearing casts, splints and braces, and those who are motivated to continue wearing them in order to avoid work or exercise, or for sympathetic social feedback. An elite athlete who wants to return to the game before the championship finals or a soldier who desires to deploy with a platoon may be more apt to adhere to the doctor’s orders in order to facilitate the healing process. A little league soccer player who does not enjoy playing the sport may do everything he or she can to avoid getting back on the field.  

The question then becomes how to determine what motivates each patient and how to alter your treatment approach to encourage healing. Recent marketing trends focus on customization and a “have it your way” approach. The patient-centered care approach, which has largely replaced the physician-centered system, utilizes these same concepts with the ultimate goals being to improve the quality of healthcare and reduce costs. For example, more traditional procedure outcome scales measure objective data that is more relevant to the physician and not the patient. More modern scales take patient satisfaction into account as well.

There is also a more team-friendly approach. Comprehensive teams of primary care managers and consultants often collaborate to determine the most appropriate treatment plan. Gone are the days of authoritarian patient care in which patients, residents, nurses and other allied healthcare professionals are hesitant to approach the staff attending with a question or suggestion to improve patient safety and satisfaction. With the patient-centered care approach, communication is improved. There is a bigger concentration on what matters to patients and what patients want and expect from their doctors and vice versa.  

Personality greatly affects motivation and podiatrists treat all age groups. It is essential to recognize the motivations of the individual patient as this has numerous implications on patient adherence and choosing appropriate treatment plans.

Although behavior is dynamic and ever changing, learning to recognize the motivations of our patients can go a long way toward facilitating safe, effective and optimal treatment.

Dr. Ryans is in private practice in St. Louis. For more Forum columns, go to www.podiatrytoday.com/section/forum.