An article from the "Personal Journal" section of the Wall Street Journal (May 18, 2010) caught my attention. The article, titled "The Power of a Gentle Nudge,"1 discusses the results of a research study recently conducted by Stanford University.
The researchers divided their subjects into three groups; subjects in the first group received a follow-up phone call from a Stanford health educator every three weeks, members of the second group received a phone call from a computer every three weeks, while subjects in the third group received no phone calls. At the end of 12 months, the researchers assessed how long each person spent exercising on a weekly basis and compared it to their baseline time spent exercising. For members of the first two groups, these phone calls contained four components that are important for us to consider:
- The participants in the study expected to receive a phone call every three weeks.
- During the phone call, each person was asked to report the amount of exercise they performed over the past week.
- Participants were congratulated on the amount of exercise they completed.
- Participants were asked how they might increase their level of exercise the next week.
Looking at these four components, I see permission, accountability, encouragement and vision. By entering the study and answering the phone, the participants gave the researchers permission to inquire into their lives. And while this permission was limited, it did involve the ability of the health educator (or computer) to ask a potentially embarrassing question that could introduce a sense of failure on the part of the participant.
Reporting on the amount of exercise accomplished was the result of a certain level of accountability on the part of the participants. They knew the question would be asked and they were willing to give their honest report, knowing that it would be recorded.
Encouraging the participants, regardless of their progress, was an obvious part of impacting their behavior. And yet, how often is this overlooked in our everyday lives?
By asking the participants how they could increase their exercise regimen, the computer (or health educator) was not asking for a commitment, just giving the participants a chance to envision themselves doing more.
After 12 months, the group that received no phone calls had increased their total number of exercise minutes per week by 28 percent. This increase was probably due to the fact that they were part of the study and knew they would be asked to report eventually. Those who received phone calls from the health educator saw a 78 percent increase in the number of minutes spent exercising weekly. This brought the group average to 178 minutes per week, already above the federally recommended level of 150 minutes per week. The group getting the computer phone calls did the best, doubling their exercise time. Perhaps the lack of a human in the interaction left people more accountable to themselves.
One of the ways that doctors of chiropractic (in general) are different than doctor of medicine (in general) is in their approach to health. With prescription pad in hand, a medical doctor can choose to take the easy road: never discussing uncomfortable topics and instead providing an instant solution (with side effects) and relieving their patients of ever having to be accountable for how they take care of their bodies. Encouragement and vision are not even part of the equation except in the mind of the patient, who envisions the drug doing everything they want and is encouraged by that thought.
Doctors of chiropractic have an opportunity to address much more than "the pain." Finding "the cause" many times involves lifestyle, nutritional and other health considerations. This pattern of permission, accountability, encouragement and vision can be applied to most of your patients, particularly the ones who smoke, eat poorly, don't exercise, etc. All it takes is consistent communication regarding the importance of good health. Most of them will eventually see the light.
While it may be uncomfortable at first, focusing on what patients really need (not just why they came in) has to be the ultimate goal. Sure, many initially will be noncompliant. But consistent, gentle nudges will eventually work on most people - particularly when they know that it comes from a genuine concern for their health and wellness. We all need encouragement to be our best. We all need to be held accountable to keep us from being lazy.
There are people who have given you permission to speak to them. We have a responsibility to tell them the truth in a loving way that they can receive. When we do our part, we can give them a vision of themselves and their life that is much more than what they may settle for if we remain silent.
Click here for more information about Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher.