November 28, 2018

How to Engage a Patient Who Is Resistant to an Intervention

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Edwin R. Raffi, MD, MPH

Harvard Medical School and Massachusetts General Hospital, Boston​​​


“What did I do so well?” OR “What could I have done better?”

These two questions often followed me on my way home every time I had an encounter with a noncompliant patient that ended up in a surprisingly remarkable or suboptimal result, respectively.

In a recent article, my colleagues, Dr Theodore A. Stern, Dr Lara N. Traeger, and I summarized lessons learned about engaging the resistant patient. Some of the main cases that have stuck with me were described. These and other stories have provided us with the guiding measures discussed in the article.

Most people do not change their minds simply because they are told to do so. If someone decides to make a change, however, a supportive and knowledgeable party and environment can enable him or her.

In order to help a patient’s evolution in decision-making, providers should practice open and nonjudgmental communication. A successful negotiating provider should perceive the patient as an equal collaborator and make this perception explicitly known to the patient.

It is the responsibility of the provider to gauge the patient’s values and beliefs and other dynamics at hand when starting negotiations for interventions. Next, the provider should implement skills to engage the patient and should use alliance-building techniques and resources. Adherence with treatment recommendations is enhanced once the patient is engaged in shared decision-making.

For example, I remember starting to thread the needle of “improving adherence to the plan” by discovering an important concept: the need for close attention to the power struggle over control in decision-making. Physicians tend to start the “change negotiation” from a position of power, which many times results in noncompliance because patients feel that they do not have enough control over the final decision. But, on occasion, patients feel that they are given too much control and would like to shift the decision-making to the provider. We call this struggle in power dynamics the “patient’s perceived control disadvantage.” Awareness of and addressing this dynamic can improve adherence by facilitating alliance-building.

Improving patient engagement in decision-making can be achieved in many other ways, including through provision of education, use of biofeedback and technology, employing humor or deterrence, etc. In all instances, providers with the best results have one quality in common: they employ creativity in an otherwise often regimented profession, thus defining the ‘art’ of practicing medicine.

Every patient interaction is a chance for a fruitful intervention, should the patient choose to participate in the plan of action. In our article, we provide a suggested flow chart for shared decision-making and examples of tools to use in engaging patients in treatment.

We hope you find this article helpful, and we welcome your individual stories, additional thoughts, and experiences that might complement these suggestions.

Financial disclosure:Dr Raffi has no relevant personal financial relationships to report.

Category: Medical Conditions , Mental Illness
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Related to Engaging the Resistant Patient in the Implementation of Interventions

One thought on “How to Engage a Patient Who Is Resistant to an Intervention

  1. The ‘art’ of practicing medicine is taught by such articles.
    Motivational interviewing is a nice technique to get good compliance from patients.
    MI consists of (OARS) open ended questions, affirmation, reflective listening, and summarising.

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