Why you’ll listen to me – but not to your doctor

by Carolyn Thomas   ♥  @HeartSisters

As I like to remind my women’s heart health presentation audiences, I am not a physician. I’m not a nurse. I am merely a dull-witted heart attack survivor. I also warn them that a lot of what I’m about to say to them is already available out there, likely printed on some wrinkled-up Heart and Stroke Foundation brochures stuffed into the magazine racks at their doctor’s office.

So when the organizer of one of my free upcoming WomenHeart talks at a large community centre where I speak twice a year called me to say that registration for this presentation is already full with a waiting list – and that’s with weeks still to go yet! – my interest was piqued.

As any experienced public speaker can appreciate, you’re only as good as the audience thinks you are. When a repeat event like mine fills up quickly thanks almost entirely to word-of-mouth buzz, this tells me that women attending this talk must be pretty darned motivated to learn more about how they can improve their heart health.

But meanwhile, many doctors I know lament the fact that it’s tough for them to motivate their patients to even think about lifestyle improvements to modify known heart disease risks. 

This suggests a weird dilemma: are women less interested in heeding their doctors’ advice than they seem to be in heeding mine? 

As Kentucky cardiologist and blogger Dr. John Mandrola likes to say:

“We urge patients to eat less, exercise more, and not to smoke. But when they don’t do these things, we still squish their blockages, burn their rogue electrical circuits, and implant lifesaving devices in their hearts.”

Meanwhile, thousands of women (and quite a few men!) are signing up on waiting lists to hear me tell them what I learned about women’s heart health at my Mayo Clinic training.  And another eight million+ of them have come here to Heart Sisters to read more of the same.

The possible answer, says Canada’s Dr. Mike Evans (of video-gone-viral 23 1/2 Hours fame) may be meaningful for doctors questioning this scenario.

During a recent TEDx talk in Belgium, he warned his fellow physicians that doctors need to rethink the way they’re trying to motivate their patients to embrace healthy lifestyle changes, in what he calls engaging peer-to-peer health care.

First, he warns that just giving patients data is clearly not working.

And then he asks his doctor colleagues:

“Who would people rather pay attention to? A real live person who is like them, somebody who has walked in their shoes – or a brochure?”

Dr. Evans tells his Belgian audience a moving story of patients telling other patients how to tell your kids you have cancer. He further warns the doctors:

“Patients are much smarter than you or I are about this subject, even it that’s our field, and what they come up with is more useful and more real.”

Dr. Evans offers three back-to-basic truisms that he says doctors should know about what works to get patients engaged:

• Stories Trump Data:  I could start off my speeches with frightening facts and figures about women’s heart disease, or I could start off by telling my audiences the frighteningly true story of how I was misdiagnosed with indigestion despite textbook heart attack symptoms (Hint: even Dr. Google knows that pain radiating down your left arm is not a symptom of acid reflux!) and how I was sent home from the E.R. and then – worse! – continued to suffer terribly for days because I felt too embarrassed to make a fuss. This is how to get their attention.

• Relationships Trump Stories:  Personal word-of-mouth recommendations are infectious, and I believe that they’ve been far more effective in filling up my presentation venues than any other form of event advertising could ever be. This is a basic tenet of marketing: consumers are highly influenced by what they’ve seen, read or heard from people they know and trust. So women who show up at my talks because of the recommendations of people they know and trust may feel like they can already trust me, too.  In Dr. Evans’ amazing little film 23 1/2 Hours, millions of people who watch it have told friends and family members they care about to watch this film, too – and they have.

• Individuals Trump Organizations:  Consumers are generally suspicious when they know that experts/doctors/speakers/websites are funded by others to say what they’re saying, so these people have to work extra hard to convince their audiences to really buy in. I once shared a conference stage on a speakers’ panel that included a cardiovascular health agency staffer, for example, who opened her speech by talking about the day her 16-year old sister suffered a stroke.  Instantly, she was perceived by our audience as not just a mouthpiece for an organization, but as an individual having powerful first-hand experience with a cause. Unless you have such a message, Dr. Evans advises, prepare to be ignored.  And then he asks doctors:

“Is what you’re saying ‘infectious’? And will somebody tell it to a loved one?”

As I wrote here, behavioural change researchers tell us that the most effective goals are ones that move you toward a particular objective, rather than away from something you’re trying to avoid.

This is the difference between proposing an avoidance goal and an approach goal.  Avoidance goals (“Do this so you won’t get sick”) are far less effective than approach goals (“Do this so you’ll feel great!)

For example, I could go out for a long bike ride today to help prevent another heart attack (which is an avoidance goal) or I could go out for a long bike ride today to stay strong and fit and because I love riding along the ocean (an approach goal).

NOTE:  Dr. Miriam Korn knows all about encouraging her patients to think about approach goals, as I wrote about when I discovered her fantastic Living Well booklet – so good that I immediately ordered 300 of these mini-workbooks (they’re free!) to distribute as audience handouts at my upcoming presentations.

Psychology professors Dr. Andrew Elliot and Dr. Ken Sheldon have pioneered research about these approach and avoidance goals(1). Their research suggests that framing a goal with an approach message is almost always more successful than framing it as an avoidance message.

Finally, I recently quoted here the words of another heart patient who had told her doctor that she’d gone online seeking more information about her condition. His reaction was telling:

“He gave that small, insulting half-laugh that doctors reserve for this response, and said that he wasn’t sure he approved of patients doing research.

“I told him I had no inclination to apologize for it. I said that I knew he was interested in my health, but not nearly as interested as I am.

“It’s his job, but it’s my life.”

I meet smart, curious, motivated women like this one every day – both during my heart health presentations as well as here on the pages of Heart Sisters.

As Dr. Mike Evans warns, doctors would do well to figure out how to reach them.

(1)  Elliot, A. J. & Sheldon, K. M. (1997). Avoidance achievement motivation: A personal goals analysis. Journal of Personality and Social Psychology, 73, 171-185.

© 2012 Carolyn Thomas  www.myheartsisters.org

See also:

• Why don’t patients listen to doctors’ heart-healthy advice?
• When you know more than your doctors about your diagnosis
• Why aren’t women heart attack survivors showing up for cardiac rehab?
• How a heart attack turned me into an “information flâneuse”
• Why are heart patients who smoke leaving hospital still smoking?
• Is your doctor telling you to “meditate, eat veggies, walk, quit smoking”? If not, why not?
• What doctors really think about women who are ‘Medical Googlers’

♥   This article was also published as a guest post on Prepared Patient™ Forum

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Q:  What works best to motivate you to make positive changes?,