Setting Successful Treatment Expectations
for Your Patients in the New Year
By Vincent Pedre, MD
You’ve created an amazing A–Z plan for your patient. You’re excited to apply all your functional medicine knowledge. They walk out the door with pamphlets, instructions, and a bag of supplements you’re sure will alter the course of their chronic illness. The patient gets home and realizes, “Oh, oh…I can’t do all this!” Two to four weeks later at follow-up, the patient tells you they only did one or two things on the list of 10 perfectly planned interventions for their condition. You feel like you failed, but really, you set your patient up for failure.
I see practitioners throwing the kitchen sink of holistic care at busy, stressed-out professionals all the time, thinking everything must be done starting today. In our accelerated, overworked, post-Internet age, often this approach will set patients up to fail. So, let’s take a pause, center ourselves, and start the New Year by reflecting on the best ways we as practitioners can help patients achieve success.
Finding out your patient’s context is just as important as taking a thorough medical history. You want to know how they live, what types of stressors they encounter on a daily basis, what their commute is like, and how open they are to lifestyle changes. Perhaps they’ve just taken in their recently separated daughter with her two young kids. Or they share an apartment with a roommate that doesn’t clean after themselves and keeps all sorts of tempting, packaged foods in the kitchen. Or they are working full-time, then arriving home to be bombarded with their parenting duties—never getting a break. Perhaps they commute an hour to and from work every day, limiting the amount of time they have to make it to the gym. Or they are in a relationship with a partner that doesn’t support their efforts to care for themselves.
All of these issues are the elephant in the room of your intervention blueprint. Unaddressed, they will weigh their influence, silently undermining any of your efforts to make positive changes. By pointing them out, you are giving the patient a much-needed listening ear for their situation, establishing rapport by showing empathy for the challenges that likely got them through your door, and helping to deflate the influence these issues have by addressing and finding practical solutions to make implementing your plan easy. Don’t make your patient fit into your plan, make the plan fit in for your patient.
I can’t tell you how many times I have seen a new patient come in with a plan devised by another holistic practitioner that involved 20 daily supplements, diet changes, IV therapy, and lifestyle interventions that would overwhelm even the most dedicated patient. It can become a full-time job in and of itself. This all-or-none approach may work for a minority, but it won’t work for most busy professionals. What I have found works well is to start with knowing your patient. Then, I like to give patients all the treatment options, but afterwards backtrack and ask them what they can start doing today that won’t overwhelm them. Sometimes it comes down to this: “What is the one thing you can do out of my recommendations that will be the easiest for you to implement right away?”
The one thing vs. the all-or-none approach can make the difference between success and failure. In all honesty, we can’t master 10 or even five different things all at once. Just as multi-tasking is really attention-splitting, as your brain can really only do one thing well at a time, accomplishing multiple tasks falls under the same rubric. I prefer sequential task stacking, starting with one goal for week one, followed by another goal added to week two, and another added in week three. You’re stacking in your approach, but by simplifying it into weekly tasks, you’re setting up the patient for success.
For example, say you want a patient to go on a gluten-free, dairy-free diet. Starting both at once will be overwhelming to many patients new to dietary approaches, who are used to having these foods regularly in their diet. Get them to master avoiding gluten in the first week, then knock out the dairy in week two. Patients often feel they need to be perfect as soon as they walk out your door. Telling them it can take up to one week to master a gluten-free diet loosens the reins of perfection that lead to failure. Keep them on this plan until their next follow-up with you in four to six weeks, and you’ll see a smiling patient boasting about how they were able to master both parts of the diet easily.
People need plug-n-play solutions. Map out their plan in as much detail as possible, so all your patient has to do is follow the instructions. Use the tools available to you in the Pillars of GI Health Program. Set the right outcome expectations. Let patients know how long it will take to achieve certain markers of success. Help them understand the path to healing is never linear; instead, it’s curvy with advancements and occasional set-backs. This is never more salient than when it comes to gut issues. If you start them on antimicrobials or antifungals, prepare them for a die-off reaction beforehand by explaining what it is and how to handle it. Nothing is worse for a patient than getting caught off guard with unexpected symptoms. Preparation ahead of time will save you distressed calls or news they stopped the treatment because they got scared about the “side effects.”
If you can, map out how often you will meet and for how many sessions. For example, with my GI patients, I usually meet with them every four weeks for the first three months, and every four to six weeks thereafter until the six-month mark. Presetting appointments helps set the expectations over how long it will take to resolve their issues. It also educates the patient on the team approach that sets functional medicine apart from conventional medicine. Let patients know that healing is a process accomplished together over time. Involve the patient in the treatment plan, and make sure it works with their schedule and resources.
No practitioner is an island. In our fast-paced world, using a team approach that augments individual touchpoints with patients will markedly increase your outcome success. I am a strong believer in adding a nutritionist or health coach to your practice to reinforce the dietary and lifestyle interventions you ask your patients to implement.
Accountability is a big factor that helps keep people’s eyes on the goal. It is easier to go off track when you don’t think anyone is looking over your shoulder. It has been proven that weight loss patients lose more weight with weekly check-ins, rather than sporadic appointments. It keeps the treatment top-of-mind, which is important for maintaining the focus on the results the patient wants to achieve. Extenders usually have more time than you may have in your schedule, thus being able to send patients text messages to check in or even call them just to see how they are coming along with the plan. These little measures go a long way in creating satisfied patients.
Speaking of accountability, there’s no better way to augment it than through technology. With Fitbits, smart scales, and smart watches, data capture is everywhere. If words can’t convince, jumping on the scale and seeing that number certainly can for most people. Even more impactful are the portable biometric devices that count steps. This may just be the extra motivation someone needs to go for a 10-minute walk after dinner and hit their 10,000 steps for the day.
On the other hand, new cloud-based technology is being used by practitioners to implement lifestyle interventions in a two-way interface that allows for daily tracking, again increasing accountability. One such example is www.mbody360.io. Using a health coach to monitor your patients and even implement pre-set diet and lifestyle plans through their smartphone allows for closer monitoring. A chat feature in the app permits the patient to text your coach with questions. Customizable in-app communications allow for daily push-notifications, offering reminders and encouragement as patients follow the plan.
No matter what technology you use, it is only as good as its implementation. When incorporating technology as part of the plan, make sure you have set clear goals and determine the outcome measures for the patient.
Informed patients are empowered patients. With these five strategies, I am sure you’ll start the new year off with creating successful patient stories!
Dr. Vincent M. Pedre is the medical director of Pedre Integrative Health and founder of Dr. Pedre Wellness, medical advisor to two health-tech start-ups (MBODY360 and Fullscript), and a functional medicine-certified practitioner in private practice in New York City since 2004.
He is a clinical instructor at the Mount Sinai School of Medicine, and is certified in yoga and medical acupuncture. On faculty at The Institute for Functional Medicine, Dr. Pedre taught the first AFMCP in Lima, Peru in November 2017.
Most recently, he joined the Lifestyle Matrix Resource Center as a Clinical Expert serving the Pillars of GI Health Program. He believes the gut is the gateway to excellent health. For this reason, he wrote the book, Happy Gut—The Cleansing Program To Help You Lose Weight, Gain Energy and Eliminate Pain, which helps people resolve digestive and gut-related health issues.