How to Put Yourself in Your Patients’ Shoes for Better Outcomes in Heath Management

February 21st, 2014

Changes in physical and mental ability caused by aging or illness are hard enough to tackle without our minds working against us. But that’s exactly what happens. The simple mindfulness technique outlined here will help you better understand what’s going on with your patients, and empower you to introduce them to their new realities more deftly, resulting in better health management outcomes for you both.

Mindfulness as a Tool

Step 1: Take a Peek at Your Own Shoes

Close your eyes and picture yourself. If you’re like most people, the self-portrait you’ve conjured in your mind is a striking likeness – of a much younger person. You’re relatively healthy, you’re reasonably active, your teeth are white, and your skin’s as wrinkle-free as is your clothing. With some practice, you can tune your imagined self to better reflect your current condition. But you’re likely to gloss over the things you’re not proud of, and retain a sparkle in your own mind’s eye that isn’t evident in the mirror. It takes uncommon effort to make the “you” of your imagination indistinguishable from your actual self.

It’s quite easy to experience this when you’ve got an acute problem at the moment. If you’ve ever had an abscessed tooth, for example, you can probably recall the pain without difficulty. But even with a warm compress held tightly to your jaw as you wait impatiently for the oral surgeon to call your name, you’d still close your eyes and see yourself smiling back with healthy teeth. The acute issue doesn’t typically change how you see yourself. You don’t define your self-image by what you consider fleeting or temporary problems.

Now pretend you’ve dedicated some time to bringing the two visions of yourself into perfect alignment.

Step 2: Look Inside Your Shoes

Looks are simple. But everyone’s self image is much richer than just physical appearance. Does your imagined self procrastinate or work too much? Does she send thank-you notes or spend sufficient time with her nieces and nephews? Does he follow through on his life-long desire to hike the Appalachian Trail or to retire to the Pacific Northwest? It’s possible.

Even if you’ve trained yourself to see your true physical reality, you’re still disposed to see the best self-image you believe represents you. It’s nice to think so highly of yourself! Nice, that is, unless you’re unable to recognize the difference between the abilities and capacities of your imagined self and your physical person. Most people, of course, are in exactly this situation.

Step 3: Be a Better Shoe Shopper

Experiencing this phenomenon regularly can help you become a more effective practitioner. Every time you recommend an intervention for a condition, you’re challenging not only the person in front of you, but also the idea that patient has of his or herself. The better job you’re able to do of understanding both of these realities, the better outcomes you’ll be able to provide.

Step 4: Try on the Right Shoes

Before you deliver the news to your patient that he’s got diabetes and will need to begin blood glucose monitoring, imagine yourself receiving the same diagnosis.

Now imagine the effort it would take to change the self-portrait that appears when you close your eyes into a diabetic person who requires blood glucose monitoring. It’s hard enough to hear the message that you’ll need to change your behavior. It’s another thing altogether to accept and embrace the new reality as the only way forward.

Step 5: Help Your Patients Find New Shoes

For a practitioner, this mindfulness exercise is a great way to help you conceptualize how difficult some of the changes you’ll be asking your patients to make will be for them to accept. But it’s just an exercise. For your patients, it’s much more.

They may be facing real, concrete, no-going-back changes that will make adherence to a care plan seriously difficult without some reimagining of their self concept. Instead of simply giving a plan and harping on the importance of keeping it, try guiding your patients to understand who they are with the new restrictions. People are generally wary of change, but we’re changing throughout our lives whether or not we’re mindful of the changes.

Even if you’re completely healthy, you’ve most likely experienced some degree of slowing down. And, you’ve seen it in others. You’ve watched an un-hittable 27-year-old MLB pitcher fade and retire before he reached 35. At some point in your life, you were a high school student. You had rules that applied to you. You had hopes and dreams and loves and losses.

Now, you almost certainly no longer think of yourself in those terms, and are no longer bound by those rules. You dream fresh dreams and love and lose differently. Sometimes it’s tempting to covet the freedoms and invincible attitude held by many adolescents, but few adults take those temptations seriously. Though you’d never have wanted to be 40 when you were 16 (how old and boring!), once you reached 40, you’d certainly never willingly go back to being 16 (how young and ignorant!). Your challenge is to find a compelling way to bring these lessons to your patients in language that speaks to their frame of reference.

Mindfulness in Practice

As you help your patients navigate various life changes, you’ll find that they come to you with four general outlooks regarding their circumstances. You’ll need to identify the stages of change so you’ll be better prepared to guide your patients to better outcomes. You may have four patients with similar health histories and similar new diagnoses for whom you’re designing individual health management plans. As you’ll see, you’ll need to present information in a very different manner for each of them – as they’re coming to you from very different places.

Stage 1: Pre-contemplative Stage

This patient closes her eyes and sees a glossy, too-perfect, younger self. She imagines that any problems she’s come to you to solve are temporary, with easy solutions. Perhaps she’s experienced a fall and broken a bone, leading to the discovery of Osteoporosis. Her self-concept revolves around activity, which she doesn’t plan to change. She views the broken bone as a fleeting inconvenience, not as a symptom of an even more threatening underlying condition.

In some ways, this stage is where you were, prior to reading the Mindfulness as a Tool section above. Once you spent a few seconds noticing that your internal vision of yourself did not comport perfectly with your waking reality, you probably grew more curious about the next steps. You’ll need to tease out this curiosity with pre-contemplative patients. Otherwise, they’ll be unlikely to successfully adhere to your plan.

For your patients in this stage, provide detailed information about their new conditions, as well as those for which they are at increased risk. Try sharing stories of another patient’s course of treatment or successful adjustment to a new reality. But often enough, patients will have anecdotes from friends or relatives that will fill in details in terms more compelling and immediate to the patient. Ask if she’s known anyone who experienced a fall. What happened next?

Your goal is to move the pre-contemplative patient to a place where she’s considering that there may be something to what you’re saying.

Stage 2: Contemplative Stage

The contemplative patient’s internal self-portrait has a furrowed brow. He may notice and be concerned about his shortness of breath as he ascends the steps to his bedroom every evening, but he also describes proudly having shoveled three cars out of his driveway during the most recent snowstorm. He became frustrated with his insurance company changing pharmacy providers and decided to just stop taking an important medication as a result. He admits this with some guilt, but it’s clear he doesn’t connect the necessary drugs to his condition with sufficient power.

When you closed your eyes and saw a face somewhat closer to your own, you started to see how you could be fooled by your mind’s eye. But you were only scratching the surface. There’s more to the closed-eye “selfie” than just what can be visually seen. If you’re to get the most from the practice, you need to dig deeper and get more into the hidden constitution of the person. Your patient in this stage needs an education about his condition and the web of related conditions, causes, risk-factors, treatments and more.

So empowered, he’ll start to see how your plan enables him to take action – and hopefully avoid becoming another snow-shoveling statistic.

Stage 3: Action Stage

Your patient in the action stage had a friend who fell and had to be hospitalized for several months. She took it upon herself to schedule a risk assessment, and now wants your help to make sure she’s doing all she can to make sure she doesn’t end up like her friend. She knows her risks, and knows the consequences of ignoring them. She seems anxious about falling.

If you came away from the exercise above interested in cultivating a self-image more congruent to your waking self, you might set aside a few minutes each day to practice. You might be motivated by self-improvement, but you might also feel unnecessarily concerned by the disparity. As you practice, you may become frustrated at what you feel is a lack of progress towards what you want. Don’t be; it took you your whole life to build that image, and it will take some time to change it.

Fill in the information blanks for your action stage patient as needed, but be sure to watch for signs that she’s experiencing undue fear or anxiety. Discuss what would happen if she did fall, so she’s not living in fear of a terrible unknown. As part of your plan, consider suggesting Lifeline with AutoAlert, a device that can automatically detect a fall1 and call for assistance even if she’s unable to do so.

Stage 4: Maintenance Stage

A patient in the maintenance stage has a firm handle on his condition and is well connected to available resources relevant to his needs. He’ll report changes as he notices them, and be responsive to your suggestions for specific ways to achieve better outcomes. Your ongoing validation and encouragement will help keep him engaged in living an active, fulfilling life.

After you’ve aligned your two self-images, you’ll notice them differ slightly from time to time. Your awareness of these instances of incongruence will help you stay mindful that we’re always changing. You’ll learn to adapt to the changes, embracing them as integral parts to your whole, whatever ramifications they carry with them. And you’ll learn to reach out for help when you’re not sure how to manage the change.

Be that sort of resource for your maintenance stage patient, providing him with new information and connecting him with new services as needed. He’ll appreciate your help with building routines that work within his abilities, and value the independence he retains by being in control of the process.

Mindfulness for Life

Spending a few minutes a day looking at yourself in your mind’s mirror may seem time poorly spent. But it will remind you constantly of the variety of degrees of self-awareness your patients will have, and help you build the skills to design interventions that will work not only due to them being the right treatments, but also due to them being presented in a way that will speak to your patients in terms they’ll understand.