Why don’t we listen to doctors’ heart-healthy advice?

change lifestyle cartoon cathy thorne

by Carolyn Thomas  @HeartSisters

Imagine that your daughter is preparing for a ski race. It’s five minutes before the start of the race. You want to give her some meaningful advice. Which one of these two messages are you going to use?

1. “Honey, remember to do XYZ – it will help you avoid falling!”
2. “Honey, remember to do XYZ – it will make you faster and you’ll have more fun!”

Austrian physician Dr. Franz Wiesbauer, writing to his fellow doctors in a Medcrunch article called Why Your Health Message Does Not Work, has asked this question many times. His conclusions? 

“Everyone chose answer #2. Why? Because it’s more encouraging. It’s an approach message – and approach goals (like happiness or success) rock!

“Our problem as physicians is that we are constantly sending out avoidance messages to our patients, and these have been proven to be much less effective.”

Researchers in the field of goal-setting theory tell us that the most effective goals are indeed ones that move you toward a particular objective (approach) rather than away from something you’re trying to avoid (avoidance).

The avoidance messages that doctors may give to their patients include:

  • “Stop smoking so you won’t develop lung cancer or heart disease!”
  • “Lose weight so you won’t get Type 2 diabetes!”
  • “Take your daily blood pressure meds so you won’t have a stroke!”

Most well-meaning doctors, Dr. Wiesbauer believes, do try to deliver this kind of sound health advice to their patients, but, based on results, it seems that we patients are just not listening:

“We tell them again, still to no avail. Frustration sets in and we ask ourselves why they come to us in the first place when they won’t do what we tell them to!”

“It’s not that these patients are stupid by any means. Many of them are really smart and successful. Most know the art of setting goals and achieving them.

“So what’s the problem we are facing here? We think it’s because the whole health-communication paradigm is broken.

“Why? Because health itself is a misnomer.”

Dr. Wiesbauer adds that if you ask patients what “health” is, many will come up with responses like “not being sick” or “not being in the hospital” –  as if health is merely the absence of disease.

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

They add that avoidance goals are also more likely to be associated with procrastination. And when we pursue avoidance goals (“I’m doing this to avoid something bad happening!”), we are far more likely to experience:

  • less satisfaction with progress and more negative feelings about progress with personal goals
  • decreased self-esteem, personal control and vitality
  • less satisfaction with life
  • less competence in relation to goal pursuits

For example, I could head out for a brisk walk today hoping that it might help to prevent another heart attack (which is an avoidance goal), or I could head out for a brisk walk today to enjoy my neighbourhood and the fresh air (an approach goal).

Or I could say NO to triple helpings at the Death by Chocolate buffet because I don’t want to gain weight (avoidance) or I could say NO because I really want to wake up tomorrow morning feeling good about my choices the night before (approach).

This approach is comparable to the lofty goals espoused by far too many motivational speakers (Follow your dreams! Reach for the stars! Eat more kale!) that heart patients often find so utterly demotivating. See also: Non-inspirational advice for heart patients

As Dr. Wiesbauer says, the average patient’s definition of health as the absence of disease counteracts the medical profession’s preventive health measures.

Reframing a health goal from avoidance to approach is where the concept of wellness enters the stage. So Dr. Wiesbauer warns his fellow physicians:

“We have to communicate to our patients the concept of wellbeing or wellness (we think that the word ‘fitness’ has too much of a sporty touch).

“Our personal wellbeing is a continuum between death, disease, health, wellbeing and perfect wellbeing. It is not a dichotomy.  Doctors and their patients have to realize that we are not either healthy or diseased. We all have our sets of risk factors and protective factors.

“We are all on a continuum and we have to strive for optimal wellbeing.”

(1) Elliot, A. J. & Sheldon, K. M. (1997). Avoidance achievement motivation: A personal goals analysis. Journal of Personality and Social Psychology, 73, 171-185.
This post was also originally published on Mind The Gap.

NOTE FROM CAROLYN:  I wrote much more about this topic in my book,  A Woman’s Guide to Living With Heart Disease (Johns Hopkins University Press, 2017). 

Q:  How have you turned an avoidance goal into an approach goal?

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See also:

12 thoughts on “Why don’t we listen to doctors’ heart-healthy advice?

  1. Pingback: RABBITS INTO HATS
  2. Dear Carolyn – thank you so much for sharing your hard fought wisdom. Your site is most informative and you are such an inspiration. I have definitely experienced some of the many of the symptoms but since the pain is not excruciating I’ve not done anything about it. I turn 60 this yearr and have always felt healthy until recently. I’ve had 3 surgeries in past 10 yrs and not sure if that increases one’s odds for heart disease. Anyway – thanks to your site, I plan to schedule an appt with my GP and will seek more than the routine ECG ordered at most recent yearly.

    I wish you my best with your new endeavour.
    SRB

    Liked by 1 person

  3. Excellent post, Carolyn! It’s very much in keeping with the work of Dr Michelle Segar, who has spent decades studying what motivates people to exercise and stick with it.

    Her findings? Long term health impacts (avoidance goals) are way too distant and iffy to get us to the gym on a regular basis. We’re not going to change our behavior now to avoid something bad 20 or 30 years down the road. What is far more motivational, according to Dr Segar’s research, is an emphasis on short-term benefits: less stress, less joint pain, more energy, more connecting with friends etc….the approach goals you’ve highlighted. Dr. Segar has summarized her research findings in her book, No Sweat, and I highly recommend it to health practitioners and those seeking to “Exorcise Exercise”.

    Finding ways to stay active that you enjoy and add value to your life increases the likelihood you’ll stick with it and reap the many health benefits of an active lifestyle. We do what we enjoy doing. I’m using Dr Segar’s recommendation to frame how I outreach and communicate at Quitting The Sitting

    Liked by 1 person

    1. Thanks so much for that recommendation of Dr. Segar’s work, Denise. You are so right when you say “We do what we enjoy doing!” – which helps to explain why I never miss a long brisk walk with my two walking groups, but can often talk myself out of a solo trip to the gym (I’m too tired, I’m too hungry, I’m too full, it’s too late, it’s too early, it’s too cold, it’s too hot, etc etc etc….) Note to readers: check out Denise’s wonderful Quitting the Sitting site!

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  4. My own doctor can attest to the frustration of a patient who does not heed his advice for wellness. Now I am paying the price, with an uncertain future with congestive heart failure among other things. His message was always a combination of approach and avoidance, but I lacked the self-discipline to implement his advice permanently in my life.

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    1. Thanks for linking to this article in your new post. I was struck by this description of your last visit with your family doctor, e.g. “…gave me a raised-voice talking-to that left me feeling ashamed and very much like a child whose parents love her no more…” Not at all an effective behaviour change technique, especially from one’s physician. No wonder you kept “…avoiding an appointment with him just to avoid the inevitable lecture…” Although his frustration is understandable, such interactions are so futile – for both of you!

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