Only when you understand what drives a person’s behaviour can you truly coach them effectively. Sometimes the results might astound you…
Mrs. W. is a delightful 80 year old woman who sees me dutifully every month for blood pressure monitoring. Every consultation has followed the same pattern: her readings are a bit high; I give health education on the benefits of lowering her blood pressure; she responds about the side effects she has experienced with the various antihypertensives we’ve tried; we hope that this new one will not cause any unwanted side effects and she leaves with a green prescription.
On this occasion though, the consultation goes differently. Mrs. W. returns informing me that she had stopped amlodipine after a week because she “just didn’t feel right” on it. This is a pattern for her. This time I decide to try a different line of questioning using some health coaching techniques and ask her to rate on a scale of 1-10 how important controlling her blood pressure is to her. After a pause she replies “Well, zero doctor, but I know it is important to you and I like coming so…” By using a different approach Mrs. W.’s own opinion is finally revealed.
We discuss the risks of not taking antihypertensives; a potential stroke sooner in life or a heart attack. Despite this Mrs. W. says that she is in her eighties, has had a great life, and would rather not take them due to side effects. I believe she has capacity to make this decision, and we agree to stop them. I feel QOF points slipping away but reflect that the savings in the pharmacy budget will in all likelihood make up for this when looking at the bigger picture. We arrange a review in a month to see how things are going. She leaves without a green piece of paper whilst I have a better understanding of her real opinion.