Blog | Thursday, December 9, 2010

Changing patient behavior with two power words

"I recommend." These are two word which, when spoken by a physician to a patient have tremendous power to change behavior. That assumes of course a trusting relationship between patient and physician (but that's a topic for another day.)

Take the colonoscopy. The U.S. Preventive Services Task Force (USPSTF) recommends that adults aged older than 50 years get a colonoscopy every 10 years. In 2005, 50% of adults aged more than 50 years in the U.S. had been screened according to these recommendations. Not surprisingly, the rate of colonoscopy screening is much lower than that of other recommended adult preventive services. I was curious: Why?

Here are two interesting facts:
1. Studies show that patients cite "physician recommendation" as the most important motivator of colorectal screening. In one study, 75% to 90% of patients who had not had a colonoscopy said that their doctor's recommendation would motivate them to undergo screening.
2. In that same study, in 50% of patients where a colonoscopy was appropriate but not done, the reason given was that the physician simply did not "bring up" the subject during the visit. Reasons included lack of time, visit was for acute problem, patient had previously declined or forget.

What the doctor says makes a difference
Turns out that the highest colonoscopy screening rates were highest among physicians who were more adamant about the need for screening. These doctors framed the recommendation (message) to the patient as coming from them self, e.g., "I recommend" or "we recommend." Doctors who framed the recommendation as coming from someone else, e.g., "they recommend" or "organization X recommends" had lower screening rates.

The following table provides examples of the different ways that physicians in this study framed their recommendation to patients for colorectal cancer screening:

A word of clarification

In these days of patient-centered care and shared decision-making, some may question the use of physician-centric directives like "I recommended." For one thing, a strong physician recommendation is what some patients want. For patients who want more than just the physician's recommendation, the physician can provide them with information to help them make their own informed decision about getting a colonoscopy.

I recommend that you give this approach a try!

Levy, B., et al. "Why Hasn't This Patient Been Screened for Colon Cancer? An Iowa Research Network Study." Journal of the American Board of Family Medicine. 2007;20:458–468.

Guerra, C., et al. "Barriers of and Facilitators to Physician Recommendation of Colorectal Cancer Screening." Journal of General Internal Medicine. 2007; 22(12):1681–8.

This post by Steven Wilkins, MPH , appeared at Get Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.