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Among all the technological and economic innovation on display at April’s MM&M Transforming Healthcare Conference, “social” was an important theme. But in almost every case, the word was paired with “media.” In other words, we were talking about how technology works, not how people feel. It left me thinking we should look more closely at human motivations in a social context as we brainstorm how to achieve patient-centric medicine.
Two things I have read in recent months helped clarify my thinking about the human element, and how it can change. Earlier this year, I saw an article in the Proceedings of the National Academy of Sciences (PNAS) showing that people at risk of chronic diseases can be motivated to adopt healthy behavior without being prodded by either a smart phone or any novel economic incentive. The secret is to pair health messages with simple “self-affirming” mental exercises that reinforce the subject’s core values.
In this study, titled “Self-affirmation alters the brain’s response to health messages and subsequent behavior change,” researchers used functional MRI scans to show the patient’s rehearsal of values affects the brain to produce the desirable outcome.
One of the authors was Vic Strecher, a professor at the University of Michigan’s School of Public Health. Vic is also a consultant to the inVentiv Health Public Relations Group. Over the years, he has popularized some of the most persuasive theories about how to entice people to make healthy choices and generally act in their own best interests.
Vic’s goal is to get people to think about the values (family, religion, politics, etc.) that matter most in their lives as they set out to change their behavior. When health goals are connected to core values, resistance to healthful advice seems to melt away. Suddenly, it becomes easier to stick to a program, whether it’s tobacco cessation, an exercise regimen, or a healthy diet.
If focusing on what matters can help us adopt healthy behavior when we are at risk of harm, I thought, perhaps it can it also help us at the end of our lives.
Certainly, the end of life is a time when many people want to focus on what matters most. In our flawed healthcare system, it’s also, often, is a time when unthinking routines and procedures take over, leaving us with more hospital-based care than we actually want.
One writer who talks about this in a personal and powerful way is Atul Gawande, a surgeon and professor at Harvard, better known as a writer for the New Yorker. In his latest book, “Being Mortal,” Gawande writes about how our medical system doesn’t prepare doctors to think about death or to discuss mortality with their patients.
He says we have to change this, and shows how you can improve patients’ circumstances at the end of their lives, to an enormous degree, if you talk to them about what they value most in this period of their lives. It may be freedom from pain. It may be preserving cognition, or the ability to enjoy food and conversation.
The course of treatment should be tailored to the values patients express, Gawande says. It may not be extending their time, but rather, feeling better for the time they have left. This is something only the patient can clarify, and the medical team should pay close heed. “When we forget this, the suffering we inflict can be barbaric,” Gawande writes. “When we remember it, the good we do can be breathtaking.”
Of course, our values and motivations are not the whole picture in healthcare. To transform our system, we need the big advances in technology and health economics that were the focus of so much discussion at the MM&M conference.
Yet, as Vic Strecher and Atul Gawande point out, we need something more than revolutionary technology to transform healthcare. We may need to pause, turn off our phones, and give human patients the time they need to talk about what matters most.
Lisa Stockman is President of Public Relations and Medical Communications at inVentiv Health
