Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.
“I really hope you aren’t going to be one of those doctors who lectures me,” my new patient said at the start of our visit. “My last doctor talked to me like a school teacher to a child, rather than to an adult man with his own business.”
The school teacher analogy struck a chord with me. More and more, doctors are being grading on “performance,” with increasing pressure to demonstrate patient achievement of various goals such as A1c reduction, statin use, and smoking cessation.
Primary care physicians are being held accountable for improving patient health parameters, even though outside of our short interaction with our patients in the exam room, we have no control over our patients’ behaviors and choices. In an average 10-minute visit, we are expected to satisfy a checklist of criteria which will be electronically zapped to a third-party payer for review, who will in turn respond with “Dear Provider” letters, charts comparing us to other physicians, and pay cuts for failing to make the grade.
Is it any wonder physicians turn to lecturing our patients?
The problem is that lectures don’t work to motivate patients. Why? Because the use of guilt and threats are horrible motivators. The same goes for doctors. Send us threatening letters, call us “non-preferred providers,” and shove pay-for-performance down our throats. You still won’t get better care out of us. And doctors won’t get better results out of our patients.
The problem is that carrots and sticks—also known as extrinsic motivators—don’t function well with the complexities of the human mind. Extrinsic motivators actually make us less likely to want to do something and even inclined to try to game the system.
What does work is intrinsic motivation: helping patients—and doctors—discover what will motivate them internally to succeed, and to determine the best steps that they can take to realistically achieve that success. By considering what we find naturally satisfying and rewarding, we can use this insight to direct our behaviors towards our goals.